Provider Demographics
NPI:1811657109
Name:HEBERT, TANNER JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:TANNER
Middle Name:JOSEPH
Last Name:HEBERT
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 1:179 GRANDE RUE
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-5048
Mailing Address - Country:US
Mailing Address - Phone:337-550-9981
Mailing Address - Fax:
Practice Address - Street 1:101 PARK WEST DR
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-8902
Practice Address - Country:US
Practice Address - Phone:337-504-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor