Provider Demographics
NPI:1043328388
Name:FREEBAIRN, GREGORY LEE (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LEE
Last Name:FREEBAIRN
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 1:6415 S 3000 E
Mailing Address - Street 2:STE 250
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6905
Mailing Address - Country:US
Mailing Address - Phone:801-553-0366
Mailing Address - Fax:801-553-0367
Practice Address - Street 1:6415 S 3000 E
Practice Address - Street 2:STE 250
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6905
Practice Address - Country:US
Practice Address - Phone:801-553-0366
Practice Address - Fax:801-553-0367
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2783521202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000058008Medicare ID - Type Unspecified
005800801Medicare UPIN