Provider Demographics
NPI:1508925314
Name:FREEDMAN CLINIC OF CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FREEDMAN CLINIC OF CHIROPRACTIC LLC
Other - Org Name:CORE HEALTH CENTERS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-670-9400
Mailing Address - Street 1:3029 SMITH RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3370
Mailing Address - Country:US
Mailing Address - Phone:330-670-9400
Mailing Address - Fax:330-670-9401
Practice Address - Street 1:3029 SMITH RD
Practice Address - Street 2:SUITE 400
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3370
Practice Address - Country:US
Practice Address - Phone:330-670-9400
Practice Address - Fax:330-670-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3312, 3412111N00000X, 111NI0900X, 111NN0400X, 111NN1001X, 111NR0200X, 111NR0400X, 111NS0005X, 111NX0100X, 111NX0800X, 261QR0200X
OHPT-9434261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherWORKER'S COMP. GROUP