Provider Demographics
NPI:1083616825
Name:FREEMAN, AGNES REGINA (DC)
Entity Type:Individual
Prefix:DR
First Name:AGNES
Middle Name:REGINA
Last Name:FREEMAN
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 1:1424 S JK POWELL BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-9145
Mailing Address - Country:US
Mailing Address - Phone:910-642-1111
Mailing Address - Fax:910-642-0111
Practice Address - Street 1:1424 S JK POWELL BLVD STE D
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-9145
Practice Address - Country:US
Practice Address - Phone:910-642-1111
Practice Address - Fax:910-642-0111
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085H6OtherBLUE CROSS BLUE SHIELD
NC89085H6Medicaid
NC2456180Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NCU92205AMedicare UPIN
NC085H6OtherBLUE CROSS BLUE SHIELD