Provider Demographics
NPI:1235252230
Name:LAVENDER, ANTHONY G (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:G
Last Name:LAVENDER
Suffix:
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:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:TOK
Mailing Address - State:AK
Mailing Address - Zip Code:99780-0317
Mailing Address - Country:US
Mailing Address - Phone:907-883-7777
Mailing Address - Fax:
Practice Address - Street 1:317 EAST FIRST
Practice Address - Street 2:
Practice Address - City:TOK
Practice Address - State:AK
Practice Address - Zip Code:99780-0317
Practice Address - Country:US
Practice Address - Phone:907-883-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA307111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist