MEDICARE: DR. ERIC GEORGE FRAZIER D.C.

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	DC23003	CA

General Provider Information

NPI Number	:	1912020652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC GEORGE FRAZIER D.C.

Provider Business Mailing Address
First Line	:	722 N MAIN ST
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-3017
Country	:	US
Telephone Number	:	707-964-6653
Fax Number	:	707-964-6990

Provider Business Practice Location Address
First Line	:	722 N MAIN ST
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-3017
Country	:	US
Telephone Number	:	707-964-6653
Fax Number	:	707-964-6990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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