Healthcare Provider Details

I. General information

NPI: 1467510024
Provider Name (Legal Business Name): VINCENT L FROST D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 RIO GRANDE BLVD NW
ALBUQUERQUE NM
87104-2631
US

IV. Provider business mailing address

1210 RIO GRANDE BLVD NW
ALBUQUERQUE NM
87104-2631
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-0466
  • Fax: 505-242-0968
Mailing address:
  • Phone: 505-247-0466
  • Fax: 505-242-0968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1583
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: