Provider Demographics
NPI:1245966761
Name:MARILYN DE FREITAS LLC
Entity type:Organization
Organization Name:MARILYN DE FREITAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER, AO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DE FREITAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-723-9669
Mailing Address - Street 1:2206 KATY FLEWELLEN RD STE 6
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7976
Mailing Address - Country:US
Mailing Address - Phone:281-723-9669
Mailing Address - Fax:
Practice Address - Street 1:2206 KATY FLEWELLEN RD STE 6
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7976
Practice Address - Country:US
Practice Address - Phone:281-723-9669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty