Provider Demographics
NPI:1891728135
Name:FREEDOM CHIROPRACTIC SERVICES MIDWEST PC
Entity Type:Organization
Organization Name:FREEDOM CHIROPRACTIC SERVICES MIDWEST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-641-0425
Mailing Address - Street 1:620 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-4130
Mailing Address - Country:US
Mailing Address - Phone:910-641-0425
Mailing Address - Fax:910-640-2054
Practice Address - Street 1:2707 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9400
Practice Address - Country:US
Practice Address - Phone:910-641-0425
Practice Address - Fax:910-640-2054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty