Provider Demographics
NPI:1205997871
Name:KERI FRESHOUR DC PC
Entity type:Organization
Organization Name:KERI FRESHOUR DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERI
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:FRESHOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-873-9610
Mailing Address - Street 1:379 W UWCHLAN AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3168
Mailing Address - Country:US
Mailing Address - Phone:610-873-9610
Mailing Address - Fax:610-873-9670
Practice Address - Street 1:379 W UWCHLAN AVE
Practice Address - Street 2:STE 100
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3168
Practice Address - Country:US
Practice Address - Phone:610-873-9610
Practice Address - Fax:610-873-9670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-005872-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherTIN