MEDICARE: DR. GEORGE E FRAUDIN JR. D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC002566L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	422117	OTHER	PA	BLUE CROSS/ BLUE SHIELD

General Provider Information

NPI Number	:	1588778245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE E FRAUDIN JR. D.C.

Provider Business Mailing Address
First Line	:	1030 BOYCE RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15241-3907
Country	:	US
Telephone Number	:	412-257-8090
Fax Number	:	412-257-8121

Provider Business Practice Location Address
First Line	:	1030 BOYCE RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15241-3907
Country	:	US
Telephone Number	:	412-257-8090
Fax Number	:	412-257-8121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	09/20/2011

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