Provider Demographics
NPI:1437210804
Name:FRASER, RANDALL CRAIG (DC PC)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:CRAIG
Last Name:FRASER
Suffix:
Gender:M
Credentials:DC PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 WADSWORTH BLVD
Mailing Address - Street 2:STE 430
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4641
Mailing Address - Country:US
Mailing Address - Phone:303-422-6301
Mailing Address - Fax:303-431-0400
Practice Address - Street 1:4350 WADSWORTH BLVD
Practice Address - Street 2:SUITE 430
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4641
Practice Address - Country:US
Practice Address - Phone:303-422-6301
Practice Address - Fax:303-431-0400
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10873Medicare ID - Type Unspecified
COT60455Medicare UPIN