Provider Demographics
NPI:1548389539
Name:FRY, JOEL R (DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:R
Last Name:FRY
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 1:1020 W CENTURY DR
Mailing Address - Street 2:STE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1679
Mailing Address - Country:US
Mailing Address - Phone:303-516-1517
Mailing Address - Fax:303-604-1517
Practice Address - Street 1:1020 W CENTURY DR
Practice Address - Street 2:STE 101
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1679
Practice Address - Country:US
Practice Address - Phone:303-516-1517
Practice Address - Fax:303-604-1517
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor