Provider Demographics
NPI:1710978887
Name:FREESEMAN, JOHN TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TODD
Last Name:FREESEMAN
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 1:229 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GORDON
Mailing Address - State:NE
Mailing Address - Zip Code:69343-1277
Mailing Address - Country:US
Mailing Address - Phone:308-282-1154
Mailing Address - Fax:308-282-1156
Practice Address - Street 1:229 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:NE
Practice Address - Zip Code:69343-1277
Practice Address - Country:US
Practice Address - Phone:308-282-1154
Practice Address - Fax:308-282-1156
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1186111N00000X
SD988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100250653-00Medicaid
SD7601223Medicaid
NE09633OtherBLUE CROSSS/BLUE SHIELD
NE100250653-00Medicaid
SD7601223Medicaid
NE277651Medicare PIN