Provider Demographics
NPI:1366434755
Name:ANTHON, GEORGE CARSON JR (DC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:CARSON
Last Name:ANTHON
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 1:105 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-4225
Mailing Address - Country:US
Mailing Address - Phone:985-542-1640
Mailing Address - Fax:985-542-3171
Practice Address - Street 1:105 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-4225
Practice Address - Country:US
Practice Address - Phone:985-542-1640
Practice Address - Fax:985-542-3171
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U37089Medicare UPIN
LA5DE23Medicare PIN
LA5S846Medicare PIN