Provider Demographics
NPI:1265430466
Name:FREIJE, BONNIE (DC)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:FREIJE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 COLLEGE DR N
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2925
Mailing Address - Country:US
Mailing Address - Phone:701-662-3443
Mailing Address - Fax:
Practice Address - Street 1:204 COLLEGE DR N
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2925
Practice Address - Country:US
Practice Address - Phone:701-662-3443
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-09
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
ND532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17073Medicaid
ND17073Medicaid
ND20469Medicare ID - Type UnspecifiedCHIROPRACTOR