Provider Demographics
NPI:1376533042
Name:FRYE, MARY P (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:P
Last Name:FRYE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:WLODYGA
Other - Last Name:FRYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:12445 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3572
Mailing Address - Country:US
Mailing Address - Phone:586-573-6622
Mailing Address - Fax:586-573-6323
Practice Address - Street 1:12445 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3572
Practice Address - Country:US
Practice Address - Phone:586-573-6622
Practice Address - Fax:586-573-6323
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMF005421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT96956Medicare UPIN
MI0P21710Medicare ID - Type Unspecified