Provider Demographics
NPI:1083794820
Name:FROST, PHILIP LEE (DC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:LEE
Last Name:FROST
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 1:3025 W LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:DORMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15216-2444
Mailing Address - Country:US
Mailing Address - Phone:412-531-2303
Mailing Address - Fax:412-531-2303
Practice Address - Street 1:3025 W LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:DORMONT
Practice Address - State:PA
Practice Address - Zip Code:15216-2444
Practice Address - Country:US
Practice Address - Phone:412-531-2303
Practice Address - Fax:412-531-2303
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001741L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0630755Medicaid
PA035344Medicare ID - Type Unspecified
PA0630755Medicaid