Provider Demographics
NPI:1508040437
Name:D FRAKER INC
Entity type:Organization
Organization Name:D FRAKER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-587-9679
Mailing Address - Street 1:2622 W MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3967
Mailing Address - Country:US
Mailing Address - Phone:406-587-9679
Mailing Address - Fax:406-587-6093
Practice Address - Street 1:2622 W MAIN ST
Practice Address - Street 2:STE B
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3967
Practice Address - Country:US
Practice Address - Phone:406-587-9679
Practice Address - Fax:406-587-9679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0164288Medicaid
MT40483OtherBLUE CROSS BLUE SHIELD
MT000082422OtherMEDICARE GROUP
MT350054790OtherRAILROAD MEDICARE
MT0164288Medicaid
MT40483OtherBLUE CROSS BLUE SHIELD