Basic Information
| Provider Information | |||||||||
| NPI: | 1063475895 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTER FOR MANUAL MEDICINE, P.A. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE CENTER FOR MANUAL MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 SW 21ST ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666044510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852718100 | ||||||||
| FaxNumber: | 7852719257 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 SW 21ST ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666044510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852718100 | ||||||||
| FaxNumber: | 7852719257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 05/10/2013 | ||||||||
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| AuthorizedOfficialLastName: | FRYE | ||||||||
| AuthorizedOfficialFirstName: | DOUG | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7852718100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | KS | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 660060 | 01 | KS | BCBS | OTHER |