Provider Demographics
NPI:1457323347
Name:HOUSSAIN, ANTHONY FAZAL (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:FAZAL
Last Name:HOUSSAIN
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 1:12205 COUNTY LINE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7719
Mailing Address - Country:US
Mailing Address - Phone:256-461-7775
Mailing Address - Fax:256-461-7756
Practice Address - Street 1:12205 COUNTY LINE RD
Practice Address - Street 2:SUITE D
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-7719
Practice Address - Country:US
Practice Address - Phone:256-461-7775
Practice Address - Fax:256-461-7756
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1995111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051505583OtherBLUE CROSS BLUE SHIELD
0005775803OtherAETNA
374479800OtherUS DEPT OF LABOR
U31364Medicare UPIN
AL051505583Medicare ID - Type UnspecifiedMEDICARE