Healthcare Provider Details

I. General information

NPI: 1356310288
Provider Name (Legal Business Name): ASHLEY FRER D.C. LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 N SHEFFIELD AVE # C-1S
CHICAGO IL
60657-8510
US

IV. Provider business mailing address

3221 N SHEFFIELD AVE # C-1S
CHICAGO IL
60657-8510
US

V. Phone/Fax

Practice location:
  • Phone: 773-325-9010
  • Fax: 773-404-5172
Mailing address:
  • Phone: 773-325-9010
  • Fax: 773-404-5172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-009436
License Number StateIL

VIII. Authorized Official

Name: ASHLEY FRER
Title or Position: OWNER
Credential: D.C.
Phone: 773-325-9010