Provider Demographics
NPI:1578226437
Name:FRUSTER, JAMAL (DC)
Entity Type:Individual
Prefix:
First Name:JAMAL
Middle Name:
Last Name:FRUSTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JAMAL
Other - Middle Name:
Other - Last Name:FRUSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3001 E SKYLINE DRIVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3001 E SKYLINE DR STE 115
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-2144
Practice Address - Country:US
Practice Address - Phone:520-344-6541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor