Provider Demographics
NPI:1952887671
Name:LOGAN J. FRAHM
Entity type:Organization
Organization Name:LOGAN J. FRAHM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FRAHM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:831-288-0627
Mailing Address - Street 1:910 CAPITOLA AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2121
Mailing Address - Country:US
Mailing Address - Phone:619-887-0179
Mailing Address - Fax:
Practice Address - Street 1:978 E LAKE AVE
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3404
Practice Address - Country:US
Practice Address - Phone:831-288-0627
Practice Address - Fax:831-851-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty