Provider Demographics
NPI:1427633080
Name:FREITAG FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:FREITAG FAMILY CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FREITAG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-818-2485
Mailing Address - Street 1:140 W 98TH ST STE 111
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-3815
Mailing Address - Country:US
Mailing Address - Phone:952-818-2485
Mailing Address - Fax:952-479-9951
Practice Address - Street 1:140 W 98TH ST STE 111
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-3815
Practice Address - Country:US
Practice Address - Phone:952-818-2485
Practice Address - Fax:952-479-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7002489OtherMINNESOTA BUSINESS REGISTRATION ID