1003252818 NPI number — FRASER CENTER OF NATURAL THERAPIES

Table of content: (NPI 1003252818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003252818 NPI number — FRASER CENTER OF NATURAL THERAPIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRASER CENTER OF NATURAL THERAPIES
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:
6
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:
1003252818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34529 UTICA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRASER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48026-3576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-285-1090
Provider Business Mailing Address Fax Number:
586-285-1099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34529 UTICA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRASER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48026-3576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-285-1090
Provider Business Practice Location Address Fax Number:
586-285-1099
Provider Enumeration Date:
05/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LUKOWSKI
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
586-285-1090

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301009695 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com