Provider Demographics
NPI:1720267024
Name:DR. DONALD FREESMEIER LTD
Entity Type:Organization
Organization Name:DR. DONALD FREESMEIER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:FREESMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-235-3933
Mailing Address - Street 1:1510 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-3931
Mailing Address - Country:US
Mailing Address - Phone:217-235-3933
Mailing Address - Fax:217-235-3948
Practice Address - Street 1:1510 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-3931
Practice Address - Country:US
Practice Address - Phone:217-235-3933
Practice Address - Fax:217-235-3948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00291072OtherRR MEDICARE
IL212947Medicare PIN