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General NPI Number Information
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NPI Number | 1821109299
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Entity Type | Individual
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Provider Name | MICHAEL JAMES FREDRICK DC
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 890 B STREET
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City | CEREDO
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State | WV
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Zip | 25507
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Country | US
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Telephone | 304-453-6194
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Fax | 304-453-5589
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Provider Business Mailing Address
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Address Line | PO BOX 713 890 B STREET
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City | CEREDO
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State | WV
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Zip | 25507
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Country | US
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Telephone | 304-453-6194
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Fax | 304-453-5589
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 189
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License Number State | WV
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