Healthcare Provider Details

I. General information

NPI: 1841286093
Provider Name (Legal Business Name): MICHAEL JAMES FRAZETTA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S PIKE RD SUITE 201
SARVER PA
16055-9298
US

IV. Provider business mailing address

117 S PIKE RD SUITE 201
SARVER PA
16055-9298
US

V. Phone/Fax

Practice location:
  • Phone: 724-353-8600
  • Fax: 724-353-8610
Mailing address:
  • Phone: 724-353-8600
  • Fax: 724-353-8610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC00S110L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: