Healthcare Provider Details

I. General information

NPI: 1417916511
Provider Name (Legal Business Name): FREDERICK ROGER WRIGHT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23843 JOY RD
DEARBORN HEIGHTS MI
48127-1480
US

IV. Provider business mailing address

23843 JOY RD
DEARBORN HEIGHTS MI
48127-1480
US

V. Phone/Fax

Practice location:
  • Phone: 313-561-6848
  • Fax: 313-561-2252
Mailing address:
  • Phone: 313-561-6848
  • Fax: 313-561-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301002832
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: