Provider Demographics
NPI:1164214201
Name:AUTHEMENT, LOGAN PAUL (DC)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:PAUL
Last Name:AUTHEMENT
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 1:1152 CANAL BLVD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4534
Mailing Address - Country:US
Mailing Address - Phone:985-449-1000
Mailing Address - Fax:985-449-1200
Practice Address - Street 1:1152 CANAL BLVD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4534
Practice Address - Country:US
Practice Address - Phone:985-449-1000
Practice Address - Fax:985-449-1200
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor