Provider Demographics
NPI:1760682827
Name:FREEDLUND FAMILY CHIROPRATIC LTD
Entity Type:Organization
Organization Name:FREEDLUND FAMILY CHIROPRATIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:S
Authorized Official - Last Name:FREEDLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-335-1381
Mailing Address - Street 1:119 S BENTON STREET
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:IL
Mailing Address - Zip Code:61088-8589
Mailing Address - Country:US
Mailing Address - Phone:815-335-1381
Mailing Address - Fax:815-335-7601
Practice Address - Street 1:119 S BENTON STREET
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:IL
Practice Address - Zip Code:61088-8589
Practice Address - Country:US
Practice Address - Phone:815-335-1381
Practice Address - Fax:815-335-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009034Medicaid
IL10127625OtherBLUE CROSS BLUE SHIELD
IL364484331OtherHEALTH SYSTEMS MANAGEMENT
IL364484331OtherHEALTH SYSTEMS MANAGEMENT