Provider Demographics
NPI:1215081237
Name:FRONZAGLIA, DAMIAN MARK (DC)
Entity type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:MARK
Last Name:FRONZAGLIA
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 1:9768 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4004
Mailing Address - Country:US
Mailing Address - Phone:954-228-4635
Mailing Address - Fax:754-229-8712
Practice Address - Street 1:9768 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4004
Practice Address - Country:US
Practice Address - Phone:954-228-4635
Practice Address - Fax:754-229-8712
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL900209396OtherTIN
FL900209396OtherTIN