Provider Demographics
NPI:1124435946
Name:FREEDOM CHIROPRACTIC HEALTH CENTER, PC
Entity type:Organization
Organization Name:FREEDOM CHIROPRACTIC HEALTH CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCHMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-356-3242
Mailing Address - Street 1:4342 15TH AVE S
Mailing Address - Street 2:STE. 104
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1100
Mailing Address - Country:US
Mailing Address - Phone:701-356-3242
Mailing Address - Fax:701-356-3298
Practice Address - Street 1:4342 15TH AVE S
Practice Address - Street 2:STE. 104
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1100
Practice Address - Country:US
Practice Address - Phone:701-356-3242
Practice Address - Fax:701-356-3298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty