Provider Demographics
NPI:1215081120
Name:FROST, JEFFREY WARD (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WARD
Last Name:FROST
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16620 N 40TH ST STE G2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3351
Mailing Address - Country:US
Mailing Address - Phone:602-992-2656
Mailing Address - Fax:602-992-2238
Practice Address - Street 1:16620 N 40TH ST STE G2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3351
Practice Address - Country:US
Practice Address - Phone:602-992-2656
Practice Address - Fax:602-992-2238
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU43867Medicare UPIN