Provider Demographics
NPI:1548583362
Name:FENOLI, ANTHONY M (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:M
Last Name:FENOLI
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 1421
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-1421
Mailing Address - Country:US
Mailing Address - Phone:318-628-9919
Mailing Address - Fax:
Practice Address - Street 1:490 THOMAS MILL RD
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-6016
Practice Address - Country:US
Practice Address - Phone:318-648-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor