Provider Demographics
NPI:1265732234
Name:DAVID L. FRERKING D.C.P.A.
Entity type:Organization
Organization Name:DAVID L. FRERKING D.C.P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:FRERKING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-343-9275
Mailing Address - Street 1:915 E ALFRED ST
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-3401
Mailing Address - Country:US
Mailing Address - Phone:352-343-9275
Mailing Address - Fax:352-343-4646
Practice Address - Street 1:915 E ALFRED ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3401
Practice Address - Country:US
Practice Address - Phone:352-343-9275
Practice Address - Fax:352-343-4646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3705111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0501522-00Medicaid
FL88684Medicare PIN
FL0501522-00Medicaid