Provider Demographics
NPI:1841314929
Name:FREY, DOUGLAS GEORGE (DC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:GEORGE
Last Name:FREY
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 1:206 GRANT ST. SW
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:IA
Mailing Address - Zip Code:52033-0456
Mailing Address - Country:US
Mailing Address - Phone:563-852-3396
Mailing Address - Fax:563-852-3565
Practice Address - Street 1:206 GRANT ST. SW
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:IA
Practice Address - Zip Code:52033-0456
Practice Address - Country:US
Practice Address - Phone:563-852-3396
Practice Address - Fax:563-852-3565
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0256768Medicaid
IA0256768Medicaid
IAU83337Medicare UPIN