Provider Demographics
NPI:1205804861
Name:HEARD, FRED R (DC)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:R
Last Name:HEARD
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 1:2352 EASTGATE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2349
Mailing Address - Country:US
Mailing Address - Phone:225-293-1400
Mailing Address - Fax:225-293-1404
Practice Address - Street 1:2352 EASTGATE DR
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2349
Practice Address - Country:US
Practice Address - Phone:225-293-1400
Practice Address - Fax:225-293-1404
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT64544Medicare UPIN
LA5S648Medicare ID - Type Unspecified