Provider Demographics
NPI:1689718801
Name:FRALEY, ALLEN RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:RAY
Last Name:FRALEY
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 1:925 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-2602
Mailing Address - Country:US
Mailing Address - Phone:509-764-1836
Mailing Address - Fax:509-764-7421
Practice Address - Street 1:925 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2602
Practice Address - Country:US
Practice Address - Phone:509-764-1836
Practice Address - Fax:509-764-7421
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA122325OtherLABOR & INDUSTRIES
WAU69463Medicare UPIN
WAABO3597Medicare ID - Type Unspecified