Provider Demographics
NPI:1609984103
Name:FROST, WILLIAM M (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
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 1:309 COSBY HWY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-2914
Mailing Address - Country:US
Mailing Address - Phone:423-623-8252
Mailing Address - Fax:423-623-7411
Practice Address - Street 1:309 COSBY HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2914
Practice Address - Country:US
Practice Address - Phone:423-623-8252
Practice Address - Fax:423-623-7411
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
4013327OtherBC BS
4013327OtherBC BS
U77105Medicare UPIN