Provider Demographics
NPI:1033522263
Name:FREEDOM CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FREEDOM CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LOVIE
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:FREE
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:314-843-0300
Mailing Address - Street 1:279 BOWLES AVE
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3921
Mailing Address - Country:US
Mailing Address - Phone:314-843-0300
Mailing Address - Fax:314-729-1015
Practice Address - Street 1:4600 S LINDBERGH BLVD
Practice Address - Street 2:STE 3
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1830
Practice Address - Country:US
Practice Address - Phone:314-843-0300
Practice Address - Fax:314-729-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007030811261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service