Provider Demographics
NPI:1154515674
Name:FRYE, CLINTON TROY (DC)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:TROY
Last Name:FRYE
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 1:2110 TROY RD STE B
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-2549
Mailing Address - Country:US
Mailing Address - Phone:618-692-1800
Mailing Address - Fax:618-692-1853
Practice Address - Street 1:2110 TROY RD STE B
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-2549
Practice Address - Country:US
Practice Address - Phone:618-692-1800
Practice Address - Fax:618-692-1853
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38011010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor