Provider Demographics
NPI:1225331747
Name:FREEDOM CHIROPRACTIC & WELLNESS CENTER LLP
Entity Type:Organization
Organization Name:FREEDOM CHIROPRACTIC & WELLNESS CENTER LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:BASKEN
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-378-7022
Mailing Address - Street 1:5115 LAKERIDGE PKWY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3003
Mailing Address - Country:US
Mailing Address - Phone:972-522-7777
Mailing Address - Fax:972-522-7793
Practice Address - Street 1:5115 LAKERIDGE PKWY
Practice Address - Street 2:SUITE 170
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3003
Practice Address - Country:US
Practice Address - Phone:972-522-7777
Practice Address - Fax:972-522-7793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty