Provider Demographics
NPI:1639242795
Name:FRYAR, BRETT (DC)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:FRYAR
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 1:2739 81ST ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2229
Mailing Address - Country:US
Mailing Address - Phone:806-745-5252
Mailing Address - Fax:806-745-3322
Practice Address - Street 1:2739 81ST ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2229
Practice Address - Country:US
Practice Address - Phone:806-745-5252
Practice Address - Fax:806-745-3322
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7846111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU70685Medicare UPIN
TX609074Medicare ID - Type Unspecified