MEDICARE: DR. CHARLES ROBERT FREY JR. DC

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	DC004563L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02836900	OTHER	PA	CAPITAL BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780762583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES ROBERT FREY JR. DC

Provider Business Mailing Address
First Line	:	13359 FERGUSON VALLEY RD
Second Line	:
City	:	YEAGERTOWN
State	:	PA
Zip	:	17099-9682
Country	:	US
Telephone Number	:	717-242-0522
Fax Number	:	717-242-0144

Provider Business Practice Location Address
First Line	:	13359 FERGUSON VALLEY RD
Second Line	:
City	:	YEAGERTOWN
State	:	PA
Zip	:	17099-9682
Country	:	US
Telephone Number	:	717-242-0522
Fax Number	:	717-242-0144

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	03/09/2015

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