Provider Demographics
NPI:1720052707
Name:FRERKING, DAVID LEWIS (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEWIS
Last Name:FRERKING
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 1:915 E ALFRED ST
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-3401
Mailing Address - Country:US
Mailing Address - Phone:352-343-9275
Mailing Address - Fax:352-343-4646
Practice Address - Street 1:915 E ALFRED ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3401
Practice Address - Country:US
Practice Address - Phone:352-343-9275
Practice Address - Fax:352-343-4646
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0501522-00Medicaid
FL0501522-00Medicaid
FL88684Medicare ID - Type Unspecified