Provider Demographics
NPI:1558392050
Name:FROST, JASON THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:THOMAS
Last Name:FROST
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 1:3050 N NAVAJO
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314
Mailing Address - Country:US
Mailing Address - Phone:928-759-0696
Mailing Address - Fax:928-759-2022
Practice Address - Street 1:3050 N NAVAJO
Practice Address - Street 2:SUITE 103
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-759-0696
Practice Address - Fax:928-759-2022
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0942490OtherBCBS
U65217Medicare UPIN
AZ0942490OtherBCBS