Provider Demographics
NPI:1366501413
Name:FRYE, BRENDA J (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:J
Last Name:FRYE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 CASTLE SHANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-2268
Mailing Address - Country:US
Mailing Address - Phone:412-341-2505
Mailing Address - Fax:412-341-0402
Practice Address - Street 1:197 CASTLE SHANNON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228-2268
Practice Address - Country:US
Practice Address - Phone:412-341-2505
Practice Address - Fax:412-341-0402
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004095L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU02668Medicare UPIN
PA626868Medicare ID - Type Unspecified