Provider Demographics
NPI:1417916511
Name:WRIGHT, FREDERICK ROGER (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ROGER
Last Name:WRIGHT
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 1:23843 JOY RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1480
Mailing Address - Country:US
Mailing Address - Phone:313-561-6848
Mailing Address - Fax:313-561-2252
Practice Address - Street 1:23843 JOY RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1480
Practice Address - Country:US
Practice Address - Phone:313-561-6848
Practice Address - Fax:313-561-2252
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1093381Medicaid
T33675Medicare UPIN
0H25043Medicare ID - Type Unspecified