Provider Demographics
NPI:1366495202
Name:STORER, FREDERICK WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:WILLIAM
Last Name:STORER
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 1:109 MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469
Mailing Address - Country:US
Mailing Address - Phone:561-741-0079
Mailing Address - Fax:561-741-0079
Practice Address - Street 1:109 MAGNOLIA WAY
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469
Practice Address - Country:US
Practice Address - Phone:561-741-0079
Practice Address - Fax:561-741-0079
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH003151111N00000X
NJMC01794111N00000X
NYX2107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U19739Medicare UPIN