Provider Demographics
NPI:1588778245
Name:FRAUDIN, GEORGE E JR (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:E
Last Name:FRAUDIN
Suffix:JR
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 1:1030 BOYCE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-3907
Mailing Address - Country:US
Mailing Address - Phone:412-257-8090
Mailing Address - Fax:412-257-8121
Practice Address - Street 1:1030 BOYCE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-3907
Practice Address - Country:US
Practice Address - Phone:412-257-8090
Practice Address - Fax:412-257-8121
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002566L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA422117OtherBLUE CROSS/ BLUE SHIELD
PA422117OtherBLUE CROSS/ BLUE SHIELD
T30320Medicare UPIN
PA422117JRVMedicare ID - Type Unspecified