Provider Demographics
NPI:1306371364
Name:FREDERICK, DAVID (PHD, ND, DHR, DSC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:PHD, ND, DHR, DSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2897
Mailing Address - Country:US
Mailing Address - Phone:717-344-0072
Mailing Address - Fax:
Practice Address - Street 1:2340 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2897
Practice Address - Country:US
Practice Address - Phone:717-344-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM103T00000X103T00000X
NM175F00000X175F00000X
NM175L00000X175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No175L00000XOther Service ProvidersHomeopath