Provider Demographics
NPI:1932323144
Name:FREESTONE CHIROPRACTIC
Entity Type:Organization
Organization Name:FREESTONE CHIROPRACTIC
Other - Org Name:PROGRESSIVE HEALTH CARE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRON
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-943-2584
Mailing Address - Street 1:724 MAINSTREET
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7625
Mailing Address - Country:US
Mailing Address - Phone:952-943-2584
Mailing Address - Fax:952-224-1379
Practice Address - Street 1:724 MAINSTREET
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7625
Practice Address - Country:US
Practice Address - Phone:952-943-2584
Practice Address - Fax:952-224-1379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
602R8FROtherBCBS
MNU40148Medicare UPIN
602R8FROtherBCBS