=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932157401
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN D FRAZIER D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2006
-----------------------------------------------------
Last Update Date | 03/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 911 S MAIN ST
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32693-3239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-463-2374
-----------------------------------------------------
Fax | 352-463-4507
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 911 S MAIN ST
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32693-3239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-463-2374
-----------------------------------------------------
Fax | 352-463-4507
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH7381
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------