Provider Demographics
NPI:1073565834
Name:FROST, MARY ELIZABETH (DC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:FROST
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BRADY ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-5214
Mailing Address - Country:US
Mailing Address - Phone:563-884-5000
Mailing Address - Fax:563-884-5000
Practice Address - Street 1:2201 11TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-4234
Practice Address - Country:US
Practice Address - Phone:309-786-2663
Practice Address - Fax:309-786-8688
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5696111N00000X
IA006987111N00000X
IL038.010998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0942560OtherBCBS
AZZ2643Medicare ID - Type Unspecified
AZ0942560OtherBCBS