Provider Demographics
NPI:1346206968
Name:FRAUNDORFER, WILLIAM GERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GERARD
Last Name:FRAUNDORFER
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 1:2507 BROAD AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-1912
Mailing Address - Country:US
Mailing Address - Phone:814-944-0404
Mailing Address - Fax:814-944-5130
Practice Address - Street 1:2507 BROAD AVENUE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-1912
Practice Address - Country:US
Practice Address - Phone:814-944-0404
Practice Address - Fax:814-944-5130
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001544L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006335050001Medicaid
PW00151633Medicare ID - Type Unspecified