Provider Demographics
NPI:1922432327
Name:FREEDOM CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:FREEDOM CHIROPRACTIC CLINIC, INC.
Other - Org Name:FREEDOM CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-849-2634
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71902-0645
Mailing Address - Country:US
Mailing Address - Phone:501-463-4965
Mailing Address - Fax:
Practice Address - Street 1:113 NICKELS ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6443
Practice Address - Country:US
Practice Address - Phone:501-463-4965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16006111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty