Provider Demographics
NPI:1437524576
Name:FRECH, DAVID (LAC, MSTOM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FRECH
Suffix:
Gender:M
Credentials:LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 N KENMORE AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5397
Mailing Address - Country:US
Mailing Address - Phone:312-498-5867
Mailing Address - Fax:
Practice Address - Street 1:4704 N KENMORE AVE APT 4A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5397
Practice Address - Country:US
Practice Address - Phone:312-498-5867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001281171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist