Provider Demographics
NPI:1215989454
Name:FRYER, SEAN JACKSON (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:JACKSON
Last Name:FRYER
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 1:22525 SE 64TH PL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5383
Mailing Address - Country:US
Mailing Address - Phone:425-369-1040
Mailing Address - Fax:425-369-1041
Practice Address - Street 1:22525 SE 64TH PL
Practice Address - Street 2:SUITE 110
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5383
Practice Address - Country:US
Practice Address - Phone:425-369-1040
Practice Address - Fax:425-369-1041
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor