Provider Demographics
NPI:1700624475
Name:FRAZIER, DEREK (DC)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:FRAZIER
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 1:130 AUSTIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-3161
Mailing Address - Country:US
Mailing Address - Phone:404-606-5252
Mailing Address - Fax:
Practice Address - Street 1:754 PEACHTREE ST NE STE 105
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1256
Practice Address - Country:US
Practice Address - Phone:404-872-4878
Practice Address - Fax:404-872-4846
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010817111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician