1700847571 NPI number — DR. EDMUND ALBERT O'NEAL D. C.

Table of content: DR. EDMUND ALBERT O'NEAL D. C. (NPI 1700847571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700847571 NPI number — DR. EDMUND ALBERT O'NEAL D. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'NEAL
Provider First Name:
EDMUND
Provider Middle Name:
ALBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D. C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEALTH CENTER
Provider Other First Name:
O'NEAL
Provider Other Middle Name:
CHIROPRACTIC
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1700847571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1611 JIMMIE DAVIS HWY
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
BOSSIER CITY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71112-4556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-752-1201
Provider Business Mailing Address Fax Number:
318-752-1203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1611 JIMMIE DAVIS HWY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BOSSIER CITY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71112-4556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-752-1201
Provider Business Practice Location Address Fax Number:
318-752-1203
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1321 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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