Provider Demographics
NPI:1700847571
Name:O'NEAL, EDMUND ALBERT (D C)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:ALBERT
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:O'NEAL
Other - Middle Name:CHIROPRACTIC
Other - Last Name:HEALTH CENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1611 JIMMIE DAVIS HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4556
Mailing Address - Country:US
Mailing Address - Phone:318-752-1201
Mailing Address - Fax:318-752-1203
Practice Address - Street 1:1611 JIMMIE DAVIS HWY
Practice Address - Street 2:SUITE A
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4556
Practice Address - Country:US
Practice Address - Phone:318-752-1201
Practice Address - Fax:318-752-1203
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU98164Medicare UPIN
LA5CH81Medicare ID - Type UnspecifiedMEDICARE NUMBER