Provider Demographics
NPI:1003923632
Name:FRAREY, DOUGLAS L (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:FRAREY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:G
Other - Last Name:SLOAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3142 GLADE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-2706
Mailing Address - Country:US
Mailing Address - Phone:231-739-8752
Mailing Address - Fax:
Practice Address - Street 1:3142 GLADE ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-2706
Practice Address - Country:US
Practice Address - Phone:231-739-8752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1677783Medicaid
MI0F15002Medicare ID - Type Unspecified