Provider Demographics
NPI:1972606143
Name:FRATTALONE, SAMUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:FRATTALONE
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 1:4641 PARK ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-4023
Mailing Address - Country:US
Mailing Address - Phone:727-544-7878
Mailing Address - Fax:727-546-9253
Practice Address - Street 1:4641 PARK ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4023
Practice Address - Country:US
Practice Address - Phone:727-544-7878
Practice Address - Fax:727-546-9253
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88449OtherBLUE CROSS/BLUE SHIELD
FLT85859Medicare UPIN
FL88449ZMedicare ID - Type UnspecifiedMEDICARE