Provider Demographics
NPI:1366560823
Name:FREIDLINE, TED J (DC)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:J
Last Name:FREIDLINE
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 1:600 S JACKSON PARK DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2626
Mailing Address - Country:US
Mailing Address - Phone:812-519-2963
Mailing Address - Fax:812-519-3515
Practice Address - Street 1:600 S JACKSON PARK DR
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2626
Practice Address - Country:US
Practice Address - Phone:812-519-2963
Practice Address - Fax:812-519-3515
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001656A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000652140OtherANTHEM
IN200091090Medicaid
INU60976Medicare UPIN
IN200091090Medicaid