Provider Demographics
NPI:1346235140
Name:FRAZETTA, SEBASTIAN JOHN (DC)
Entity Type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:JOHN
Last Name:FRAZETTA
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 1:846 PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15144-1623
Mailing Address - Country:US
Mailing Address - Phone:724-274-9440
Mailing Address - Fax:724-274-0858
Practice Address - Street 1:846 PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:PA
Practice Address - Zip Code:15144-1623
Practice Address - Country:US
Practice Address - Phone:724-274-9440
Practice Address - Fax:724-274-0858
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005111L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA150259H9JMedicare ID - Type Unspecified
U37611Medicare UPIN