Healthcare Provider Details

I. General information

NPI: 1881995975
Provider Name (Legal Business Name): NATHANAEL TIMOTHY FREY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 INDEPENDENCE DR
NAPOLEON OH
43545-9194
US

IV. Provider business mailing address

1380 SEDWARD AVE
NAPOLEON OH
43545-2263
US

V. Phone/Fax

Practice location:
  • Phone: 419-592-7966
  • Fax: 419-599-0635
Mailing address:
  • Phone: 419-966-7249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4120
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: