Provider Demographics
NPI:1922504422
Name:FRYAUF, MATTHEW CHARLES (DC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:CHARLES
Last Name:FRYAUF
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 1:130 SW 2ND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-4157
Mailing Address - Country:US
Mailing Address - Phone:503-263-3033
Mailing Address - Fax:503-263-3023
Practice Address - Street 1:130 SW 2ND AVE STE 101
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-4157
Practice Address - Country:US
Practice Address - Phone:503-263-3033
Practice Address - Fax:503-263-3023
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor