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General NPI Number Information
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NPI Number | 1508053521
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Entity Type | Organization
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Legal Business Name | DEWANE D. FRASE, D.C., P.C.
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | N9691 STATE HIGHWAY 13
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City | PHILLIPS
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State | WI
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Zip | 54555-7771
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Country | US
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Telephone | 715-339-2052
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Fax | 715-339-2014
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Provider Business Mailing Address
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Address Line | N9691 STATE HIGHWAY 13
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City | PHILLIPS
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State | WI
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Zip | 54555-7771
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Country | US
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Telephone | 715-339-2052
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Fax | 715-339-2014
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. DEWANE D FRASE
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Credential | D.C.
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Telephone | 715-339-2052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3088-12
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License Number State | WI
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