Provider Demographics
NPI:1144521303
Name:MEDINA, DAVID ANTONIO (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTONIO
Last Name:MEDINA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 CALEF HWY 103
Mailing Address - Street 2:
Mailing Address - City:EPPING
Mailing Address - State:NH
Mailing Address - Zip Code:03042-1614
Mailing Address - Country:US
Mailing Address - Phone:603-679-3222
Mailing Address - Fax:603-679-3222
Practice Address - Street 1:69 HUSTONVILLE ST.
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539
Practice Address - Country:US
Practice Address - Phone:606-787-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor