Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH9174 | FL |
NPI | 1013014190 |
---|---|
Provider Name | Dr. Susan Blair Fries |
First Address | Vero Beach, FL 32963-2310 |
Second Address | Vero Beach, FL 32963-2310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |