# FRIDLEY CHIROPRACTIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124335286
- **Authorized official:** AMY FRIDLEY (SINGLE MEMBER)
- **Authorized official phone:** (636) 332-1769

## Contact information

- **Practice address:** 1126 W PEARCE BLVD, STE 114, WENTZVILLE, MO 63385-1053
- **Practice address phone:** (636) 332-1769
- **Practice address fax:** (636) 639-9235
- **Mailing address:** 1126 W PEARCE BLVD, STE 114, WENTZVILLE, MO 63385-1053
- **Mailing address phone:** (636) 332-1769
- **Mailing address fax:** (636) 639-9235

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 2000161195 | MO | Yes |

## Other

- **Enumeration date:** 09/09/2010
- **Last updated:** 09/09/2010