Provider Demographics
NPI:1619563632
Name:FREEDOM CHIROPRACTIC
Entity Type:Organization
Organization Name:FREEDOM CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDDARTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-590-7976
Mailing Address - Street 1:PO BOX 2230
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-2230
Mailing Address - Country:US
Mailing Address - Phone:307-586-5301
Mailing Address - Fax:
Practice Address - Street 1:1302 BECK AVE STE A
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3758
Practice Address - Country:US
Practice Address - Phone:307-586-5301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty