Provider Demographics
NPI:1285838235
Name:FRAZER FAMILY CHIROPRACTIC & WELLNESS CENTER
Entity type:Organization
Organization Name:FRAZER FAMILY CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NIRAV
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-407-0015
Mailing Address - Street 1:384 LANCASTER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FRAZER
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1804
Mailing Address - Country:US
Mailing Address - Phone:610-407-0015
Mailing Address - Fax:610-407-0091
Practice Address - Street 1:6758 MARKET STREET
Practice Address - Street 2:HORIZON MEDICAL CENTER
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082
Practice Address - Country:US
Practice Address - Phone:610-887-0100
Practice Address - Fax:610-887-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1559591OtherHIGHMARK
PA2255908000OtherIBC
PA2255908000OtherIBC