Provider Demographics
NPI:1699756205
Name:FYE, BRETT ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ALLEN
Last Name:FYE
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 1:1405 E WALTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-7111
Mailing Address - Country:US
Mailing Address - Phone:814-946-0279
Mailing Address - Fax:814-946-9039
Practice Address - Street 1:1405 E WALTON AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-7111
Practice Address - Country:US
Practice Address - Phone:814-946-0279
Practice Address - Fax:814-946-9039
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009207200001Medicaid
PA400544OtherUPMC
PAFY1592850OtherBLUE SHIELD
PAU98967Medicare UPIN
PA077101Medicare ID - Type Unspecified