MEDICARE: DR. SOPHIA ANASTASIA ANTONINI DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	14958	FL

General Provider Information

NPI Number	:	1285460444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHIA ANASTASIA ANTONINI DC

Provider Business Mailing Address
First Line	:	3545 SAINT JOHNS BLUFF RD S STE 2A
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-2654
Country	:	US
Telephone Number	:	904-201-9397
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 SAINT JOHNS BLUFF RD S STE 2A
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-2654
Country	:	US
Telephone Number	:	904-201-9397
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2024
Last Update Date	:	09/12/2024

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