Provider Demographics
NPI:1669497061
Name:FRISBIE, CHAUNCEY BLAKE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAUNCEY
Middle Name:BLAKE
Last Name:FRISBIE
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 1:715 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:KS
Mailing Address - Zip Code:67356-2464
Mailing Address - Country:US
Mailing Address - Phone:620-795-2323
Mailing Address - Fax:620-795-2323
Practice Address - Street 1:715 10TH ST.
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:KS
Practice Address - Zip Code:67356
Practice Address - Country:US
Practice Address - Phone:620-795-2323
Practice Address - Fax:620-795-2324
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060457OtherBC/BS
KS060457FRMedicare ID - Type Unspecified
KSU73652Medicare UPIN