Provider Demographics
NPI:1053818005
Name:FRIDLEY, WILLIAM KRISTOFER (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KRISTOFER
Last Name:FRIDLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 BURNET RD STE 2
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-2853
Mailing Address - Country:US
Mailing Address - Phone:512-266-1000
Mailing Address - Fax:512-266-1000
Practice Address - Street 1:410 PRESSLER ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-5100
Practice Address - Country:US
Practice Address - Phone:512-266-1000
Practice Address - Fax:512-266-1000
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13738111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician