Provider Demographics
NPI:1063584365
Name:FREEDMAN, GARRY NEAL (DC)
Entity type:Individual
Prefix:DR
First Name:GARRY
Middle Name:NEAL
Last Name:FREEDMAN
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 1:536 REVERE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-4704
Mailing Address - Country:US
Mailing Address - Phone:781-284-6652
Mailing Address - Fax:781-284-6594
Practice Address - Street 1:536 REVERE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-4704
Practice Address - Country:US
Practice Address - Phone:781-284-6652
Practice Address - Fax:781-284-6594
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor