Provider Demographics
NPI:1912419326
Name:HEALTH CENTERED OF SEYMOUR, INC.
Entity Type:Organization
Organization Name:HEALTH CENTERED OF SEYMOUR, INC.
Other - Org Name:HEALTH CENTERED SPINE & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:J
Authorized Official - Last Name:FREIDLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-519-2963
Mailing Address - Street 1:1725 E TIPTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-3561
Mailing Address - Country:US
Mailing Address - Phone:812-519-2963
Mailing Address - Fax:
Practice Address - Street 1:1725 E TIPTON ST STE 200
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-3561
Practice Address - Country:US
Practice Address - Phone:812-519-2963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001579A111N00000X
111N00000X, 207Q00000X, 363LF0000X
IN01060426A207R00000X
IN71003405A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty