Healthcare Provider Details

I. General information

NPI: 1780057778
Provider Name (Legal Business Name): JAMES RUSSELL FRASER III D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 MARKET ST
BASALT CO
81621-7409
US

IV. Provider business mailing address

67 WIDGET ST UNIT 714
BASALT CO
81621-6705
US

V. Phone/Fax

Practice location:
  • Phone: 970-924-1015
  • Fax:
Mailing address:
  • Phone: 970-924-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11712
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR.0008508
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: