Healthcare Provider Details

I. General information

NPI: 1124084074
Provider Name (Legal Business Name): COLIN W FROGLEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4769 SOQUEL DR
SOQUEL CA
95073-2457
US

IV. Provider business mailing address

4769 SOQUEL DR
SOQUEL CA
95073-2457
US

V. Phone/Fax

Practice location:
  • Phone: 831-462-3350
  • Fax: 831-462-6258
Mailing address:
  • Phone: 831-462-3350
  • Fax: 831-462-6258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number17438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: