Provider Demographics
NPI:1235007147
Name:FREDERICK, LAUREN (DC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 MAIDENBLUSH DR
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-4401
Mailing Address - Country:US
Mailing Address - Phone:724-674-8991
Mailing Address - Fax:
Practice Address - Street 1:657C PITTSBURGH RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16002-4033
Practice Address - Country:US
Practice Address - Phone:724-586-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC012070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty