Provider Demographics
NPI:1669419842
Name:FREEMAN, JEFFREY SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223-1402
Mailing Address - Country:US
Mailing Address - Phone:609-390-0571
Mailing Address - Fax:609-390-8871
Practice Address - Street 1:16 ROOSEVELT BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223-1402
Practice Address - Country:US
Practice Address - Phone:609-390-0571
Practice Address - Fax:609-390-8871
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00196300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1083559Medicaid
NJT73176Medicare UPIN
NJFR451306Medicare ID - Type Unspecified