Provider Demographics
NPI:1508053521
Name:DEWANE D. FRASE, D.C., P.C.
Entity Type:Organization
Organization Name:DEWANE D. FRASE, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEWANE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FRASE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-339-2052
Mailing Address - Street 1:N9691 STATE HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS
Mailing Address - State:WI
Mailing Address - Zip Code:54555-7771
Mailing Address - Country:US
Mailing Address - Phone:715-339-2052
Mailing Address - Fax:715-339-2014
Practice Address - Street 1:N9691 STATE HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:WI
Practice Address - Zip Code:54555-7771
Practice Address - Country:US
Practice Address - Phone:715-339-2052
Practice Address - Fax:715-339-2014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3088-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38939800Medicaid
WI38939800Medicaid