MEDICARE: FREDERICK CHIROPRACTIC

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	00033949	WA

General Provider Information

NPI Number	:	1427487248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREDERICK CHIROPRACTIC

Provider Business Mailing Address
First Line	:	2501 SE MILE HILL DR
Second Line	:	STE. A-101
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3500
Country	:	US
Telephone Number	:	360-895-4843
Fax Number	:	360-895-4210

Provider Business Practice Location Address
First Line	:	2501 SE MILE HILL DR
Second Line	:	STE. A-101
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3500
Country	:	US
Telephone Number	:	360-895-4843
Fax Number	:	360-895-4210

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KENNETH B FREDERICK
Credential	:	D.C.
Telephone Number	:	360-895-4843

Provider Enumeration Date	:	11/02/2013
Last Update Date	:	11/02/2013

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Directions to “FREDERICK CHIROPRACTIC ” Practice Location

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