Provider Demographics
NPI:1114127305
Name:FREE CHIROPRACTIC CENTRE
Entity Type:Organization
Organization Name:FREE CHIROPRACTIC CENTRE
Other - Org Name:RONALD V. FREE DC PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FORRESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-479-4220
Mailing Address - Street 1:364 HIDDEN OAKS TRL NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-6741
Mailing Address - Country:US
Mailing Address - Phone:423-310-1004
Mailing Address - Fax:
Practice Address - Street 1:364 HIDDEN OAKS TRL NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-6741
Practice Address - Country:US
Practice Address - Phone:423-310-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3970836Medicare PIN