Provider Demographics
NPI:1417938184
Name:FRAZIER, JED LAMAR (DC)
Entity Type:Individual
Prefix:DR
First Name:JED
Middle Name:LAMAR
Last Name:FRAZIER
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 1:185 S MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:KAMAS
Mailing Address - State:UT
Mailing Address - Zip Code:84036-9597
Mailing Address - Country:US
Mailing Address - Phone:435-783-2838
Mailing Address - Fax:435-783-2840
Practice Address - Street 1:185 S MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:KAMAS
Practice Address - State:UT
Practice Address - Zip Code:84036-9597
Practice Address - Country:US
Practice Address - Phone:435-783-2838
Practice Address - Fax:435-783-2840
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5049945-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT50499451200001OtherBCBS
UT67337OtherPEHP
UT50499451277001OtherVALUECARE
UT870395551005Medicaid
UT50499451277001OtherHEALTHWISE
UT50499451277001OtherFEDERAL
UTQM0000056512OtherALTIUS
UT870395551005Medicaid