Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301005134 | MI |
NPI | 1003923632 |
---|---|
Provider Name | Douglas L Frarey |
First Address | Muskegon, MI 49444-2706 |
Second Address | Muskegon, MI 49444-2706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 16/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1677783 | (05) | MI |