Provider Demographics
NPI:1851733893
Name:HANNIE, FREDERICK GEORGE JR (DC)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:GEORGE
Last Name:HANNIE
Suffix:JR
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 1:2301 E PRIEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7976
Mailing Address - Country:US
Mailing Address - Phone:337-477-0600
Mailing Address - Fax:337-474-4935
Practice Address - Street 1:2301 E PRIEN LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7976
Practice Address - Country:US
Practice Address - Phone:337-477-0600
Practice Address - Fax:337-474-4935
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor