Provider Demographics
NPI:1851303440
Name:FREITAG, TERRY K (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:K
Last Name:FREITAG
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 1:714 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1039
Mailing Address - Country:US
Mailing Address - Phone:608-328-8304
Mailing Address - Fax:608-328-1870
Practice Address - Street 1:714 4TH AVE W
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1039
Practice Address - Country:US
Practice Address - Phone:608-328-8304
Practice Address - Fax:608-328-1870
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI01267-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38809800Medicaid
WI75393Medicare ID - Type Unspecified
WIT61947Medicare UPIN