Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 13738 | TX |
NPI | 1053818005 |
---|---|
Provider Name | Dr. William Kristofer Fridley |
First Address | Austin, TX 78757-2853 |
Second Address | Austin, TX 78703-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2018 |
Last Update Date | 06/04/2018 |