Provider Demographics
NPI:1245227511
Name:FRATTINI, EDWARD MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MARTIN
Last Name:FRATTINI
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 1:22701 GREATER MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2007
Mailing Address - Country:US
Mailing Address - Phone:586-777-6056
Mailing Address - Fax:585-775-7246
Practice Address - Street 1:22701 GREATER MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2007
Practice Address - Country:US
Practice Address - Phone:586-777-6056
Practice Address - Fax:585-775-7246
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI141979434Medicaid
MI0E05199OtherBCBS
MITR077OtherPPOM
MI0E05199Medicare ID - Type Unspecified
MITR077OtherPPOM