Provider Demographics
NPI:1902833957
Name:FREITAG, BRAD K (DC)
Entity Type:Individual
Prefix:DR
First Name:BRAD
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 1:1019 RIVER ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BELLEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53508-9181
Mailing Address - Country:US
Mailing Address - Phone:608-424-1840
Mailing Address - Fax:608-424-1815
Practice Address - Street 1:1019 RIVER ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-9181
Practice Address - Country:US
Practice Address - Phone:608-424-1840
Practice Address - Fax:608-424-1815
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3786-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38932700Medicaid
WI38932700Medicaid