Provider Demographics
NPI:1043293723
Name:FREELEY, MARY THERESA (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY THERESA
Middle Name:
Last Name:FREELEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7-11 SUFFERN PL
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5501
Mailing Address - Country:US
Mailing Address - Phone:845-368-8727
Mailing Address - Fax:845-368-8777
Practice Address - Street 1:7-11 SUFFERN PL
Practice Address - Street 2:SUITE 109
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5501
Practice Address - Country:US
Practice Address - Phone:845-368-8727
Practice Address - Fax:845-368-8777
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-27
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V04210Medicare UPIN
NYX8G751Medicare ID - Type Unspecified