Provider Demographics
NPI:1922305697
Name:FREAD FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:FREAD FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:EZRA
Authorized Official - Last Name:FREAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-236-0648
Mailing Address - Street 1:5308 PARKLANE DR STE 5
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8629
Mailing Address - Country:US
Mailing Address - Phone:308-237-0648
Mailing Address - Fax:308-236-9197
Practice Address - Street 1:5308 PARKLANE DR STE 5
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8629
Practice Address - Country:US
Practice Address - Phone:308-237-0648
Practice Address - Fax:308-236-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty