Provider Demographics
NPI:1134389034
Name:MATTHEW FREY, L.AC., LLC
Entity type:Organization
Organization Name:MATTHEW FREY, L.AC., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-313-6642
Mailing Address - Street 1:806 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2920
Mailing Address - Country:US
Mailing Address - Phone:503-538-7338
Mailing Address - Fax:503-538-7339
Practice Address - Street 1:806 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2920
Practice Address - Country:US
Practice Address - Phone:503-538-7338
Practice Address - Fax:503-538-7339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC-01155261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center