Provider Demographics
NPI:1609944354
Name:FRANGEDAKIS, PAUL JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOHN
Last Name:FRANGEDAKIS
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 1:3320 PARTNER PL
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3628
Mailing Address - Country:US
Mailing Address - Phone:859-223-5527
Mailing Address - Fax:859-223-5527
Practice Address - Street 1:3320 PARTNER PL
Practice Address - Street 2:SUITE 112
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3628
Practice Address - Country:US
Practice Address - Phone:859-223-5527
Practice Address - Fax:859-223-5527
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4214111N00000X
MI2301008472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000050780OtherANTHEM
4400180OtherUNITED HEALTHCARE
NY350055667Medicaid
6070109Medicare ID - Type Unspecified