Provider Demographics
NPI:1194858910
Name:FRASURE, DAVID WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WAYNE
Last Name:FRASURE
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 1:1690 RAYMOND DIEHL RD
Mailing Address - Street 2:SUITE B3
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-1588
Mailing Address - Country:US
Mailing Address - Phone:850-224-4268
Mailing Address - Fax:850-224-4212
Practice Address - Street 1:1690 RAYMOND DIEHL RD
Practice Address - Street 2:SUITE B3
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-1588
Practice Address - Country:US
Practice Address - Phone:850-224-4268
Practice Address - Fax:850-224-4212
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003193111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55808OtherPIN
FLK8548OtherGROUP
FL88390OtherBLUE CROSS BLUE SHIELD
FLCH0003193OtherSTATE LICENSE
FL88390AMedicare ID - Type Unspecified
FLT55808OtherPIN