Provider Demographics
NPI:1932466737
Name:FRYAR CHIROPRACTIC CENTER, PA
Entity Type:Organization
Organization Name:FRYAR CHIROPRACTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FRYAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-745-5252
Mailing Address - Street 1:2739 81ST ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2229
Mailing Address - Country:US
Mailing Address - Phone:806-745-5252
Mailing Address - Fax:806-745-3322
Practice Address - Street 1:2739 81ST ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2229
Practice Address - Country:US
Practice Address - Phone:806-745-5252
Practice Address - Fax:806-745-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7846111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609074Medicare UPIN