Provider Demographics
NPI:1790811628
Name:FRICKE, DANIEL MARCUS (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MARCUS
Last Name:FRICKE
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 1:16708 BOTHELL EVERETT HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6345
Mailing Address - Country:US
Mailing Address - Phone:425-286-2712
Mailing Address - Fax:425-286-2713
Practice Address - Street 1:16708 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6345
Practice Address - Country:US
Practice Address - Phone:425-286-2712
Practice Address - Fax:425-286-2713
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602 572 420OtherUBI
WA55-0916031OtherTIN