Provider Demographics
NPI:1306900014
Name:FRAKER, DUSTIN M (DC)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:M
Last Name:FRAKER
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 1:2622 W MAIN ST
Mailing Address - Street 2:STE. B
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3967
Mailing Address - Country:US
Mailing Address - Phone:406-587-9679
Mailing Address - Fax:406-587-6093
Practice Address - Street 1:2622 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3967
Practice Address - Country:US
Practice Address - Phone:406-587-9679
Practice Address - Fax:406-587-6093
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT42223OtherBLUE CROSS BLUE SHIELD
MT0164281Medicaid
MT0164288Medicaid
MT350054790OtherRAILROAD MEDICARE
MT350054790OtherRAILROAD MEDICARE
MT0164288Medicaid