Healthcare Provider Details

I. General information

NPI: 1497369250
Provider Name (Legal Business Name): ANIMUS CHIROPRACTIC AND ALTERNATIVE MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N CAUSEWAY BLVD STE 2
MANDEVILLE LA
70471-3429
US

IV. Provider business mailing address

1120 N CAUSEWAY BLVD STE 2
MANDEVILLE LA
70471-3429
US

V. Phone/Fax

Practice location:
  • Phone: 985-778-2695
  • Fax:
Mailing address:
  • Phone: 985-778-2695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AUSTIN FONTENOT
Title or Position: OWNER/PROVIDER
Credential: DC
Phone: 985-705-5392