Active NPI
Robert Fredrickson, D.C.
- Chiropractor
- Dallas, TX
National Provider Identifier
1164847661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 12519
- Practice address
- 4015 Main Street
Suite 100
Dallas, TX 75226 - Phone
- (512) 818-4025
- NPI assigned
- Feb 20, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 12519 | TX | Primary |
Addresses
Primary practice location
4015 Main Street
Suite 100
Dallas, TX 75226
Mailing address
PO Box 1773
Georgetown, TX 78627-1773
Phone (512) 818-4025
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12519 | TX | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1392854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392854400000",
"number": "1164847661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1773",
"city": "GEORGETOWN",
"state": "TX",
"postal_code": "786271773",
"telephone_number": "512-818-4025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4015 MAIN STREET",
"address_2": "SUITE 100",
"city": "DALLAS",
"state": "TX",
"postal_code": "75226",
"telephone_number": "512-818-4025"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDRICKSON",
"first_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-02-20",
"last_updated": "2014-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "TX",
"license": "12519",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.