Provider Demographics
NPI:1144669029
Name:DANIEL MARCUS FRICKE PROFESSIONAL SERVIE CORPORATION
Entity type:Organization
Organization Name:DANIEL MARCUS FRICKE PROFESSIONAL SERVIE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MARCUS
Authorized Official - Last Name:FRICKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-286-2712
Mailing Address - Street 1:16708 BOTHELL EVERETT HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6345
Mailing Address - Country:US
Mailing Address - Phone:425-286-2712
Mailing Address - Fax:425-286-2713
Practice Address - Street 1:16708 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6345
Practice Address - Country:US
Practice Address - Phone:425-286-2712
Practice Address - Fax:425-286-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 00034295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1790811628OtherINDIVIDUAL NPI