Provider Demographics
NPI:1457377350
Name:FREY, PAULA EDITH (DC)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:EDITH
Last Name:FREY
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 1:343 N WYCOFF AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-4014
Mailing Address - Country:US
Mailing Address - Phone:360-621-8186
Mailing Address - Fax:
Practice Address - Street 1:343 N WYCOFF AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-4014
Practice Address - Country:US
Practice Address - Phone:360-621-8186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1265622Medicare ID - Type UnspecifiedMEDICARE ID NUMBER