Provider Demographics
NPI:1841286093
Name:FRAZETTA, MICHAEL JAMES (DC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:FRAZETTA
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 1:117 S PIKE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-9298
Mailing Address - Country:US
Mailing Address - Phone:724-353-8600
Mailing Address - Fax:724-353-8610
Practice Address - Street 1:117 S PIKE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-9298
Practice Address - Country:US
Practice Address - Phone:724-353-8600
Practice Address - Fax:724-353-8610
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC00S110L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA509450H9JMedicare ID - Type Unspecified
U37611Medicare UPIN