Provider Demographics
NPI:1255524856
Name:BACON, DANNY SCOTT (DC)
Entity type:Individual
Prefix:MR
First Name:DANNY
Middle Name:SCOTT
Last Name:BACON
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 1:1400 ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5608
Mailing Address - Country:US
Mailing Address - Phone:318-323-7246
Mailing Address - Fax:318-323-7265
Practice Address - Street 1:1400 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5608
Practice Address - Country:US
Practice Address - Phone:318-323-7246
Practice Address - Fax:318-323-7265
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor