Provider Demographics
NPI:1881995975
Name:FREY, NATHANAEL TIMOTHY (DC)
Entity type:Individual
Prefix:DR
First Name:NATHANAEL
Middle Name:TIMOTHY
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 1:1380 SEDWARD AVE
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-2263
Mailing Address - Country:US
Mailing Address - Phone:419-966-7249
Mailing Address - Fax:
Practice Address - Street 1:390 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-9194
Practice Address - Country:US
Practice Address - Phone:419-592-7966
Practice Address - Fax:419-599-0635
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor