Provider Demographics
NPI:1619517646
Name:FREEMAN CHIROPRACTIC WELLNESS CENTER
Entity type:Organization
Organization Name:FREEMAN CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-642-1111
Mailing Address - Street 1:1424 S JK POWELL BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-9145
Mailing Address - Country:US
Mailing Address - Phone:910-642-1111
Mailing Address - Fax:910-642-0111
Practice Address - Street 1:1424 S JK POWELL BLVD
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-9167
Practice Address - Country:US
Practice Address - Phone:910-642-1111
Practice Address - Fax:910-642-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085H6OtherBLUE CROSS BLUE SHIELD
NC89085H6Medicaid