1285838235 NPI number — FRAZER FAMILY CHIROPRACTIC & WELLNESS CENTER

Table of content: (NPI 1285838235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285838235 NPI number — FRAZER FAMILY CHIROPRACTIC & WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRAZER FAMILY CHIROPRACTIC & WELLNESS CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HORIZON MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285838235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
384 LANCASTER AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
FRAZER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19355-1804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-407-0015
Provider Business Mailing Address Fax Number:
610-407-0091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6758 MARKET STREET
Provider Second Line Business Practice Location Address:
HORIZON MEDICAL CENTER
Provider Business Practice Location Address City Name:
UPPER DARBY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-887-0100
Provider Business Practice Location Address Fax Number:
610-887-0109
Provider Enumeration Date:
06/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
NIRAV
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CHIROPRACTOR OWNER
Authorized Official Telephone Number:
610-407-0015

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC008991 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1559591 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2255908000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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