Provider Demographics
NPI:1619049541
Name:FREED, FREDERICK SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:SCOTT
Last Name:FREED
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 66TH ST NORTH
Mailing Address - Street 2:
Mailing Address - City:ST . PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710
Mailing Address - Country:US
Mailing Address - Phone:727-347-3400
Mailing Address - Fax:727-347-0502
Practice Address - Street 1:1224 66TH ST NORTH
Practice Address - Street 2:
Practice Address - City:ST . PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710
Practice Address - Country:US
Practice Address - Phone:727-347-3400
Practice Address - Fax:727-347-0502
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5113111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70820Medicare ID - Type Unspecified