Provider Demographics
NPI:1356437289
Name:FRALEY, JOSEPH MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:FRALEY
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 1:1123 MECHEM DR # 2
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-7203
Mailing Address - Country:US
Mailing Address - Phone:575-258-5999
Mailing Address - Fax:575-258-1548
Practice Address - Street 1:1123 MECHEM DR
Practice Address - Street 2:SUITE 2
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7203
Practice Address - Country:US
Practice Address - Phone:505-937-4307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0A3992Medicare PIN