Provider Demographics
NPI:1447469184
Name:RODRIGUE, FRED PAUL JR (DC)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:PAUL
Last Name:RODRIGUE
Suffix:JR
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14249 HEATHERTON AVE
Mailing Address - Street 2:
Mailing Address - City:PRIDE
Mailing Address - State:LA
Mailing Address - Zip Code:70770-9720
Mailing Address - Country:US
Mailing Address - Phone:225-336-1920
Mailing Address - Fax:225-343-8399
Practice Address - Street 1:229 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-3059
Practice Address - Country:US
Practice Address - Phone:225-336-1920
Practice Address - Fax:225-343-8399
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor