Provider Demographics
NPI:1497060081
Name:FRYE, DEREK DUSTIN (DC)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:DUSTIN
Last Name:FRYE
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 1:670 N MACARTHUR BLVD # 100
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2733
Mailing Address - Country:US
Mailing Address - Phone:972-745-4446
Mailing Address - Fax:972-745-2597
Practice Address - Street 1:670 N MACARTHUR BLVD # 100
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019
Practice Address - Country:US
Practice Address - Phone:972-745-4446
Practice Address - Fax:972-745-2597
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor