Provider Demographics
NPI:1629128533
Name:FRACHTMAN, JEFFREY A (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:FRACHTMAN
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 1:4621 NORTH UNVERSITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2014
Mailing Address - Country:US
Mailing Address - Phone:954-341-5544
Mailing Address - Fax:954-341-5444
Practice Address - Street 1:4621 NORTH UNVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2014
Practice Address - Country:US
Practice Address - Phone:954-341-5544
Practice Address - Fax:954-341-5444
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88524Medicare ID - Type Unspecified