Provider Demographics
NPI:1497369250
Name:ANIMUS CHIROPRACTIC AND ALTERNATIVE MEDICINE, LLC
Entity Type:Organization
Organization Name:ANIMUS CHIROPRACTIC AND ALTERNATIVE MEDICINE, LLC
Other - Org Name:ESSENTIAL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-705-5392
Mailing Address - Street 1:1120 N CAUSEWAY BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3429
Mailing Address - Country:US
Mailing Address - Phone:985-778-2695
Mailing Address - Fax:
Practice Address - Street 1:1120 N CAUSEWAY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3429
Practice Address - Country:US
Practice Address - Phone:985-778-2695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699121822OtherINDIVIDUAL NPI