Provider Demographics
NPI:1467515585
Name:FRAZER, CARY SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:SCOTT
Last Name:FRAZER
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 1:2677 ROUTE 34
Mailing Address - Street 2:SUITE C
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8577
Mailing Address - Country:US
Mailing Address - Phone:630-551-0000
Mailing Address - Fax:630-551-1510
Practice Address - Street 1:2677 ROUTE 34
Practice Address - Street 2:SUITE C
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8577
Practice Address - Country:US
Practice Address - Phone:630-551-0000
Practice Address - Fax:630-551-1510
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04727085OtherBCBS PROVIDER NUMBER
IL623230Medicare ID - Type UnspecifiedPROVIDER NUMBER
IL04727085OtherBCBS PROVIDER NUMBER