Provider Demographics
NPI:1457470965
Name:FRASIER, NATHANIAL JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHANIAL
Middle Name:JAMES
Last Name:FRASIER
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 1:4480 RAY BOLL BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-1760
Mailing Address - Country:US
Mailing Address - Phone:812-373-9880
Mailing Address - Fax:812-373-9910
Practice Address - Street 1:4480 RAY BOLL BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-1760
Practice Address - Country:US
Practice Address - Phone:812-373-9880
Practice Address - Fax:812-373-9910
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002325A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN08002325AOtherLICENCE NUMBER
IN200894220AMedicaid