Provider Demographics
NPI:1164864062
Name:FREEDOM CHIROPRACTIC & REHAB LLC
Entity Type:Organization
Organization Name:FREEDOM CHIROPRACTIC & REHAB LLC
Other - Org Name:FREEDOM CHIROPRACTIC & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KOLENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-886-0385
Mailing Address - Street 1:435 SARTARTIA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-9684
Mailing Address - Country:US
Mailing Address - Phone:832-886-0385
Mailing Address - Fax:261-254-7892
Practice Address - Street 1:435 SARTARTIA RD
Practice Address - Street 2:SUITE B
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-9684
Practice Address - Country:US
Practice Address - Phone:832-886-0385
Practice Address - Fax:261-254-7892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty