Provider Demographics
NPI:1700417359
Name:FONTENOT, GARRIN (DC)
Entity Type:Individual
Prefix:
First Name:GARRIN
Middle Name:
Last Name:FONTENOT
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 1:204 PETROLEUM DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3880
Mailing Address - Country:US
Mailing Address - Phone:337-266-9949
Mailing Address - Fax:337-266-9951
Practice Address - Street 1:204 PETROLEUM DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3880
Practice Address - Country:US
Practice Address - Phone:337-266-9949
Practice Address - Fax:337-266-9951
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor