Provider Demographics
NPI:1700817681
Name:FRYE, DAN A (DC)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:A
Last Name:FRYE
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 1:3566 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4918
Mailing Address - Country:US
Mailing Address - Phone:760-724-8918
Mailing Address - Fax:
Practice Address - Street 1:510 ESCONDIDO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6169
Practice Address - Country:US
Practice Address - Phone:760-726-8101
Practice Address - Fax:760-726-2967
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC20454Medicare ID - Type UnspecifiedSTATE ID NUMBER
CAU43168Medicare UPIN