Provider Demographics
NPI:1851480651
Name:FREESMEIER, DONALD E (DC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:FREESMEIER
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 1:1510 BROADWAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-3931
Mailing Address - Country:US
Mailing Address - Phone:217-235-3933
Mailing Address - Fax:217-235-3948
Practice Address - Street 1:1510 BROADWAY AVENUE
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-3931
Practice Address - Country:US
Practice Address - Phone:217-235-3933
Practice Address - Fax:217-235-3948
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00291072OtherRR MEDICARE
ILP00291072OtherRR MEDICARE