Provider Demographics
NPI:1154342830
Name:FREEMAN, THOMAS A (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:FREEMAN
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 1:2860 BECKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5413
Mailing Address - Country:US
Mailing Address - Phone:336-765-4917
Mailing Address - Fax:336-794-7473
Practice Address - Street 1:458 KNOLLWOOD ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3426
Practice Address - Country:US
Practice Address - Phone:336-765-9292
Practice Address - Fax:336-794-7473
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085JGOtherBCBS PROV NUMBER
NC085JGOtherBCBS PROV NUMBER
NC2455190Medicare ID - Type Unspecified