Provider Demographics
NPI:1386780773
Name:FRYE, BROOKE NICHOLE (DC)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:NICHOLE
Last Name:FRYE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:BROOKE
Other - Middle Name:NICHOLE
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3809 S STATE ROUTE 159
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3020
Mailing Address - Country:US
Mailing Address - Phone:618-692-1800
Mailing Address - Fax:618-205-8664
Practice Address - Street 1:3809 S. STATE ROUTE 159
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-3020
Practice Address - Country:US
Practice Address - Phone:618-692-1800
Practice Address - Fax:618-205-8664
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.010829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor