Provider Demographics
NPI:1992181127
Name:FREEDOM CHIROPRACTIC INC
Entity Type:Organization
Organization Name:FREEDOM CHIROPRACTIC INC
Other - Org Name:PROWELLNESS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-508-7127
Mailing Address - Street 1:11876 OLIO RD
Mailing Address - Street 2:#500
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9765
Mailing Address - Country:US
Mailing Address - Phone:317-595-9620
Mailing Address - Fax:317-595-9630
Practice Address - Street 1:11876 OLIO RD
Practice Address - Street 2:#500
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9765
Practice Address - Country:US
Practice Address - Phone:317-595-9620
Practice Address - Fax:317-595-9630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002407A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty