Provider Demographics
NPI:1669577995
Name:FRY, DANIEL C (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:FRY
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 1:27131 CALLE ARROYO
Mailing Address - Street 2:SUITE 1702
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2700
Mailing Address - Country:US
Mailing Address - Phone:949-830-3539
Mailing Address - Fax:949-489-3749
Practice Address - Street 1:27131 CALLE ARROYO
Practice Address - Street 2:SUITE 1702
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2700
Practice Address - Country:US
Practice Address - Phone:949-830-3539
Practice Address - Fax:949-489-3749
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
17397Medicare UPIN