=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689924862
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISS CATHERINE THERESE FRATTINI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2012
-----------------------------------------------------
Last Update Date | 09/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22701 GREATER MACK AVE
-----------------------------------------------------
City | SAINT CLAIR SHORES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48080-2007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-777-6056
-----------------------------------------------------
Fax | 586-775-7246
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1522 ALINE DR
-----------------------------------------------------
City | GROSSE POINTE WOODS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48236-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-881-2529
-----------------------------------------------------
Fax | 586-775-7246
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2301009878
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------