=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265732234
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID L. FRERKING D.C.P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2010
-----------------------------------------------------
Last Update Date | 03/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 915 E ALFRED ST
-----------------------------------------------------
City | TAVARES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32778-3401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-343-9275
-----------------------------------------------------
Fax | 352-343-4646
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 915 E ALFRED ST
-----------------------------------------------------
City | TAVARES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32778-3401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-343-9275
-----------------------------------------------------
Fax | 352-343-4646
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DAVID LEWIS FRERKING
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 352-343-9275
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NI0900X
-----------------------------------------------------
Taxonomy Name | Internist Chiropractor
-----------------------------------------------------
License Number | CH3705
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------