Provider Demographics
NPI:1104312735
Name:LOPEZ, ANTHONY WILLIAM JR (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:WILLIAM
Last Name:LOPEZ
Suffix:JR
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 1:310 W OLD PASS RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-4528
Mailing Address - Country:US
Mailing Address - Phone:601-870-0732
Mailing Address - Fax:
Practice Address - Street 1:15007 CREOSOTE RD STE A
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4392
Practice Address - Country:US
Practice Address - Phone:228-533-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor