Provider Demographics
NPI:1033289814
Name:DERRATT, FRANK C (DC)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:C
Last Name:DERRATT
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 1:1990 WESTWOOD BLVD.
Mailing Address - Street 2:STE #110
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-475-3488
Mailing Address - Fax:310-475-3574
Practice Address - Street 1:1990 WESTWOOD BLVD.
Practice Address - Street 2:STE #110
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-475-3488
Practice Address - Fax:310-943-0425
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC15183OtherDC LICENSE