Provider Demographics
NPI:1023172095
Name:ANTHONY, DOROTHY JEAN (DC, DACBN)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:JEAN
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:DC, DACBN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11322 STATE ROUTE 29
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:PA
Mailing Address - Zip Code:18801-7159
Mailing Address - Country:US
Mailing Address - Phone:570-278-4400
Mailing Address - Fax:
Practice Address - Street 1:11322 STATE ROUTE 29
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:PA
Practice Address - Zip Code:18801-7159
Practice Address - Country:US
Practice Address - Phone:570-278-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002023L111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00009847340001Medicaid
PA0009847340001Medicaid
PA0009847340001Medicaid
PAAN424528Medicare UPIN
AN424528Medicare ID - Type Unspecified