MEDICARE: FRYE CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1407692825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRYE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	306 5TH ST
Second Line	:
City	:	CARROLLTON
State	:	IL
Zip	:	62016-1325
Country	:	US
Telephone Number	:	217-942-6272
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 5TH ST
Second Line	:
City	:	CARROLLTON
State	:	IL
Zip	:	62016-1325
Country	:	US
Telephone Number	:	217-942-6272
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ETHAN FRYE
Credential	:	DC
Telephone Number	:	217-883-9863

Provider Enumeration Date	:	07/04/2024
Last Update Date	:	07/04/2024

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Directions to “FRYE CHIROPRACTIC LLC ” Practice Location

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