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General NPI Number Information
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NPI Number | 1447469184
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Entity Type | Individual
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Provider Name | FRED PAUL RODRIGUE JR. D.C.
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 229 S JEFFERSON AVE
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City | PORT ALLEN
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State | LA
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Zip | 70767-3059
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Country | US
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Telephone | 225-336-1920
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Fax | 225-343-8399
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Provider Business Mailing Address
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Address Line | 14249 HEATHERTON AVE
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City | PRIDE
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State | LA
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Zip | 70770-9720
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Country | US
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Telephone | 225-336-1920
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Fax | 225-343-8399
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1170
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License Number State | LA
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