Provider Demographics
NPI:1669695102
Name:FRIAS, D MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:D
Middle Name:MICHAEL
Last Name:FRIAS
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 1:3848 W CARSON ST STE 103
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6704
Mailing Address - Country:US
Mailing Address - Phone:310-897-5889
Mailing Address - Fax:310-944-9460
Practice Address - Street 1:3848 W CARSON ST STE 103
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6704
Practice Address - Country:US
Practice Address - Phone:310-897-5889
Practice Address - Fax:310-944-9460
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 30398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor