1508053521 NPI number — DEWANE D. FRASE, D.C., P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508053521 NPI number — DEWANE D. FRASE, D.C., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEWANE D. FRASE, D.C., P.C.
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:
Provider Other Organization Name Type Code:
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:
1508053521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N9691 STATE HIGHWAY 13
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILLIPS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54555-7771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-339-2052
Provider Business Mailing Address Fax Number:
715-339-2014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N9691 STATE HIGHWAY 13
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILLIPS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54555-7771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-339-2052
Provider Business Practice Location Address Fax Number:
715-339-2014
Provider Enumeration Date:
10/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FRASE
Authorized Official First Name:
DEWANE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
715-339-2052

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3088-12 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 38939800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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