Provider Demographics
NPI:1912246562
Name:FRALEY CHIROPRACTIC, INC.P.S.
Entity Type:Organization
Organization Name:FRALEY CHIROPRACTIC, INC.P.S.
Other - Org Name:ALLEN R. FRALEY, D.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:D.C. / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-764-1836
Mailing Address - Street 1:925 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-2602
Mailing Address - Country:US
Mailing Address - Phone:509-764-1836
Mailing Address - Fax:509-764-7231
Practice Address - Street 1:925 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2602
Practice Address - Country:US
Practice Address - Phone:509-764-1836
Practice Address - Fax:509-764-7231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty