Provider Demographics
NPI:1891973848
Name:GONZALES, FREDERIC RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:RYAN
Last Name:GONZALES
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 1:903 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-3037
Mailing Address - Country:US
Mailing Address - Phone:985-542-6400
Mailing Address - Fax:985-542-6403
Practice Address - Street 1:903 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-3037
Practice Address - Country:US
Practice Address - Phone:985-542-6400
Practice Address - Fax:985-542-6403
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9469111N00000X
LA1515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor