MEDICARE: FRATTINI CHIROPRACTIC SERVICES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OEO5199	OTHER	MI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	95OEO51990	OTHER	MI	BCN
4	TR077	OTHER	MI	PPOM

General Provider Information

NPI Number	:	1568766533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRATTINI CHIROPRACTIC SERVICES PC

Provider Business Mailing Address
First Line	:	22701 GREATER MACK AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-2007
Country	:	US
Telephone Number	:	586-777-6056
Fax Number	:	586-775-7246

Provider Business Practice Location Address
First Line	:	22701 GREATER MACK AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-2007
Country	:	US
Telephone Number	:	586-777-6056
Fax Number	:	586-775-7246

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. CARLA MARGARET HOYLOCK
Credential	:
Telephone Number	:	586-777-6056

Provider Enumeration Date	:	01/05/2011
Last Update Date	:	01/07/2011

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Directions to “FRATTINI CHIROPRACTIC SERVICES PC ” Practice Location

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