Provider Demographics
NPI:1790891232
Name:FROST, DOREEN S (DC)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:S
Last Name:FROST
Suffix:
Gender:F
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:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:PETERSHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01366-0753
Mailing Address - Country:US
Mailing Address - Phone:978-724-3424
Mailing Address - Fax:978-724-0034
Practice Address - Street 1:6 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PETERSHAM
Practice Address - State:MA
Practice Address - Zip Code:01366-9500
Practice Address - Country:US
Practice Address - Phone:978-724-3424
Practice Address - Fax:978-724-0034
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36451OtherBLUE CROSS
MA202000OtherTUFTS
MA202000OtherTUFTS
MAY36451OtherBLUE CROSS