Provider Demographics
NPI:1235843376
Name:FREDRICKSON, HANNAH CLAIRE (DC)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:CLAIRE
Last Name:FREDRICKSON
Suffix:
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 1:1232 JUNGERMANN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6963
Mailing Address - Country:US
Mailing Address - Phone:636-685-0717
Mailing Address - Fax:636-685-0721
Practice Address - Street 1:1232 JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6963
Practice Address - Country:US
Practice Address - Phone:636-685-0717
Practice Address - Fax:636-685-0721
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022048904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor