Provider Demographics
NPI:1952503120
Name:FREELEY CHIROPRACTIC
Entity type:Organization
Organization Name:FREELEY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREELEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-642-9951
Mailing Address - Street 1:7-11 SUFFERN PL
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5501
Mailing Address - Country:US
Mailing Address - Phone:845-368-8727
Mailing Address - Fax:845-368-8777
Practice Address - Street 1:7-11 SUFFERN PL
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5501
Practice Address - Country:US
Practice Address - Phone:845-368-8727
Practice Address - Fax:845-368-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV04210Medicare UPIN
NYV04210Medicare UPIN
NYX8G751Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMEB