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General NPI Number Information
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NPI Number | 1427487248
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Entity Type | Organization
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Legal Business Name | FREDERICK CHIROPRACTIC
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 11/02/2013
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Provider Practice Location Address
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Address Line | 2501 SE MILE HILL DR STE. A-101
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City | PORT ORCHARD
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State | WA
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Zip | 98366-3500
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Country | US
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Telephone | 360-895-4843
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Fax | 360-895-4210
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Provider Business Mailing Address
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Address Line | 2501 SE MILE HILL DR STE. A-101
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City | PORT ORCHARD
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State | WA
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Zip | 98366-3500
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Country | US
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Telephone | 360-895-4843
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Fax | 360-895-4210
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH B FREDERICK
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Credential | D.C.
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Telephone | 360-895-4843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 00033949
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License Number State | WA
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