Provider Demographics
NPI:1821276197
Name:FRASIER CHIROPRACTIC AND SPORTS CLINIC, INC.
Entity Type:Organization
Organization Name:FRASIER CHIROPRACTIC AND SPORTS CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIAL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FRASIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-343-5252
Mailing Address - Street 1:3200 SYCAMORE COURT #1D
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-1513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 SYCAMORE COURT #1D
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-1513
Practice Address - Country:US
Practice Address - Phone:812-343-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002325A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN08002325AOtherCHIROPRACTIC LICENSE