Provider Demographics
NPI:1578687869
Name:FRISK, WILLIAM CARL (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CARL
Last Name:FRISK
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 1:2159 AIRLINE DR
Mailing Address - Street 2:SUITE #300
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3197
Mailing Address - Country:US
Mailing Address - Phone:318-746-2225
Mailing Address - Fax:318-746-2225
Practice Address - Street 1:2159 AIRLINE DR
Practice Address - Street 2:SUITE #300
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3197
Practice Address - Country:US
Practice Address - Phone:318-746-2225
Practice Address - Fax:318-746-2225
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C487Medicare ID - Type UnspecifiedMEDICARE PART B