Provider Demographics
NPI:1275731887
Name:FRAZER FAMILY CHIROPRACTIC AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:FRAZER FAMILY CHIROPRACTIC AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NIRAV
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-887-0100
Mailing Address - Street 1:7200 CHESTNUT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-3125
Mailing Address - Country:US
Mailing Address - Phone:610-887-0100
Mailing Address - Fax:610-887-0109
Practice Address - Street 1:7200 CHESTNUT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-3125
Practice Address - Country:US
Practice Address - Phone:610-887-0100
Practice Address - Fax:610-887-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1559591OtherHIGHMARK
PA2255908000OtherIBC
PA2255908000OtherIBC