Provider Demographics
NPI:1780869339
Name:FRYDRYCH, FRANK W JR (DC)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:W
Last Name:FRYDRYCH
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:929 S MAIN ST
Mailing Address - Street 2:UNIT 107A
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3364
Mailing Address - Country:US
Mailing Address - Phone:630-519-6284
Mailing Address - Fax:866-443-0749
Practice Address - Street 1:929 S MAIN ST
Practice Address - Street 2:UNIT 107A
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3364
Practice Address - Country:US
Practice Address - Phone:630-519-6284
Practice Address - Fax:866-443-0749
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
R00055OtherMEDICARE PTAN