Provider Demographics
NPI:1548214554
Name:FREEMAN CHIROPRACTIC CARE LLC
Entity Type:Organization
Organization Name:FREEMAN CHIROPRACTIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER (SOLE PROPRIETOR)
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-390-0571
Mailing Address - Street 1:16 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223-1402
Mailing Address - Country:US
Mailing Address - Phone:609-390-0571
Mailing Address - Fax:609-390-8871
Practice Address - Street 1:16 ROOSEVELT BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223-1402
Practice Address - Country:US
Practice Address - Phone:609-390-0571
Practice Address - Fax:609-390-8871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00196300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1083559Medicaid
NJT73176Medicare UPIN
NJFR451306Medicare ID - Type Unspecified