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General NPI Number Information
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NPI Number | 1326541046
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Entity Type | Organization
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Legal Business Name | FREDERICK CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 03/09/2018
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Last Update Date | 03/09/2018
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Provider Practice Location Address
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Address Line | 10310 MONCREIFFE RD STE 103
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City | RALEIGH
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State | NC
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Zip | 27617-7814
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Country | US
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Telephone | 561-358-1451
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Fax |
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Provider Business Mailing Address
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Address Line | 1218 TAYLOR CT APT A
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City | CARY
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State | NC
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Zip | 27511-4995
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Country | US
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Telephone | 561-358-1451
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | TAYLOR FREDERICK
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Credential | DC
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Telephone | 561-358-1451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4860
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License Number State | NC
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