Provider Demographics
NPI:1154397347
Name:MENDEZ, ANTONIO THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:THOMAS
Last Name:MENDEZ
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 1:207 E REYNOLDS RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-1276
Mailing Address - Country:US
Mailing Address - Phone:859-273-4455
Mailing Address - Fax:859-272-9134
Practice Address - Street 1:207 E REYNOLDS RD
Practice Address - Street 2:SUITE 160
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-1276
Practice Address - Country:US
Practice Address - Phone:859-273-4455
Practice Address - Fax:859-272-9134
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYV06842Medicare UPIN