Provider Demographics
NPI:1184722621
Name:CASPER, FREDERICK GERALD (DC)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:GERALD
Last Name:CASPER
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 1:901 W WALL ST
Mailing Address - Street 2:STE 101
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051
Mailing Address - Country:US
Mailing Address - Phone:817-481-4246
Mailing Address - Fax:817-481-4254
Practice Address - Street 1:901 W WALL ST
Practice Address - Street 2:STE 101
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:817-481-4246
Practice Address - Fax:817-481-4254
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F5750OtherBCBS
U901604Medicare UPIN
TX8537B6Medicare ID - Type Unspecified
TXTXB120662Medicare PIN