Provider Demographics
NPI:1215993225
Name:FRIAR, DALE (DC)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:
Last Name:FRIAR
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 1:1909 HIGHWAY 17 BYP N
Mailing Address - Street 2:SUITE I
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7459
Mailing Address - Country:US
Mailing Address - Phone:843-971-0540
Mailing Address - Fax:843-971-0340
Practice Address - Street 1:1909 HIGHWAY 17 BYP N
Practice Address - Street 2:SUITE I
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7459
Practice Address - Country:US
Practice Address - Phone:843-971-0540
Practice Address - Fax:843-971-0340
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1731Medicaid
SC382554419OtherTAX IDENTIFICATION NUMBER
SCT328850281Medicare PIN
SC382554419OtherTAX IDENTIFICATION NUMBER