Provider Demographics
NPI:1558434209
Name:RAY M FREEMAN DC PC
Entity Type:Organization
Organization Name:RAY M FREEMAN DC PC
Other - Org Name:FREEMAN CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:361-578-9945
Mailing Address - Street 1:2806 N NAVARRO
Mailing Address - Street 2:SUITE O
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3937
Mailing Address - Country:US
Mailing Address - Phone:361-578-9945
Mailing Address - Fax:361-578-9145
Practice Address - Street 1:2806 N NAVARRO
Practice Address - Street 2:SUITE O
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3937
Practice Address - Country:US
Practice Address - Phone:361-578-9945
Practice Address - Fax:361-578-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8B7835OtherBCBS
TX001054801Medicaid
TX8F20597Medicare PIN
TX600810Medicare PIN