Provider Demographics
NPI:1508924929
Name:FREEDMAN, JEREMIAH EZRA (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:EZRA
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3624 W MARKET ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4510
Mailing Address - Country:US
Mailing Address - Phone:330-670-9400
Mailing Address - Fax:330-670-9401
Practice Address - Street 1:3624 W MARKET ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4510
Practice Address - Country:US
Practice Address - Phone:330-670-9400
Practice Address - Fax:330-670-9401
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3312111NI0900X, 111NN0400X, 111NN1001X, 111NR0200X, 111NR0400X, 111NS0005X, 111NT0100X, 111NX0100X, 111NX0800X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0900XChiropractic ProvidersChiropractorInternist
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NT0100XChiropractic ProvidersChiropractorThermography
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000314225OtherANTHEM BC BS
OH000000314225OtherANTHEM BC BS