Individual provider Active NPI

Deirdre Leigh Dantonio, D.C.

  • Chiropractor
  • Medford, OR
National Provider Identifier
1508053158
Registry record updated Sep 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
282576 Issued in OR
Practice address
10 Crater Lake Ave
Medford, OR 97504-7445
Phone
(541) 608-0169
NPI assigned
Sep 27, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 27, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 282576 OR Primary
Chiropractor 111N00000X 782 MT

Addresses

Primary practice location

10 Crater Lake Ave
Medford, OR 97504-7445

Mailing address

5003 Griffin Creek Rd
Medford, OR 97501-9586
Phone (541) 608-0488

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060313000162 OR Practitioner - Chiropractic 3274552443 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1982
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

408 Crater Lake Ave
Medford, OR 97504-6808
Phone (541) 608-0169

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
782MTMDChiropractor
282576ORMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
D'Antonio Chiropractic Clinic LLC Chiropractor CurrentSince Aug 15, 2017 Accepting new patients

Locations

408 Crater Lake Ave
Medford, OR 97504
Phone (214) 697-5701

10 Crater Lake Ave
Medford, OR 97504
Phone (541) 608-0169

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190851200000",
    "number": "1508053158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5003 GRIFFIN CREEK RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975019586",
            "telephone_number": "541-608-0488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 CRATER LAKE AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047445",
            "telephone_number": "541-608-0169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANTONIO",
        "first_name": "DEIRDRE",
        "middle_name": "LEIGH",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-27",
        "last_updated": "2007-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "282576",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MT",
            "license": "782",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.