Healthcare Provider Details

I. General information

NPI: 1366851347
Provider Name (Legal Business Name): TIMOTHY LUKE FRIEH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1742 W 10TH AVE
EUGENE OR
97402-3710
US

IV. Provider business mailing address

1742 W 10TH AVE
EUGENE OR
97402-3710
US

V. Phone/Fax

Practice location:
  • Phone: 541-343-8449
  • Fax:
Mailing address:
  • Phone: 541-343-8449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5491
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: