Provider Demographics
NPI:1861025611
Name:FREEFORM CHIROPRACTIC TROPHY CLUB LLC
Entity Type:Organization
Organization Name:FREEFORM CHIROPRACTIC TROPHY CLUB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MCAFEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:817-308-4309
Mailing Address - Street 1:930 HILLTOP DR STE 102
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5943
Mailing Address - Country:US
Mailing Address - Phone:817-308-4309
Mailing Address - Fax:817-598-1150
Practice Address - Street 1:2240 SH 114
Practice Address - Street 2:SUITE 650
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262
Practice Address - Country:US
Practice Address - Phone:817-308-4309
Practice Address - Fax:817-598-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty