Healthcare Provider Details

I. General information

NPI: 1366434755
Provider Name (Legal Business Name): GEORGE CARSON ANTHON JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S CHERRY ST
HAMMOND LA
70403-4225
US

IV. Provider business mailing address

105 S CHERRY ST
HAMMOND LA
70403-4225
US

V. Phone/Fax

Practice location:
  • Phone: 985-542-1640
  • Fax: 985-542-3171
Mailing address:
  • Phone: 985-542-1640
  • Fax: 985-542-3171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number809
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: