Provider Demographics
NPI:1417337916
Name:FREY FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FREY FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-308-6577
Mailing Address - Street 1:10412 FLOYD ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-2999
Mailing Address - Country:US
Mailing Address - Phone:219-308-6577
Mailing Address - Fax:
Practice Address - Street 1:714 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3236
Practice Address - Country:US
Practice Address - Phone:219-308-6577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002786A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty