Provider Demographics
NPI:1609051614
Name:FREY, MATTHEW (LAC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:FREY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S COLLEGE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3110
Mailing Address - Country:US
Mailing Address - Phone:503-313-6642
Mailing Address - Fax:503-419-9873
Practice Address - Street 1:108 S COLLEGE ST
Practice Address - Street 2:SUITE B
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3110
Practice Address - Country:US
Practice Address - Phone:503-313-6642
Practice Address - Fax:503-419-9873
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01155171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist