Provider Demographics
NPI:1962561472
Name:FREDERICK R. WRIGHT, D.C.
Entity type:Organization
Organization Name:FREDERICK R. WRIGHT, D.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-561-6848
Mailing Address - Street 1:23843 JOY RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1480
Mailing Address - Country:US
Mailing Address - Phone:313-561-6848
Mailing Address - Fax:313-561-2252
Practice Address - Street 1:23843 JOY RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1480
Practice Address - Country:US
Practice Address - Phone:313-561-6848
Practice Address - Fax:313-561-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1093381Medicaid
MI1093381Medicaid
MIT33675Medicare UPIN