Provider Demographics
NPI:1699758441
Name:FREEBERN, KEVIN LEE (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEE
Last Name:FREEBERN
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 1:918 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-2126
Mailing Address - Country:US
Mailing Address - Phone:309-752-0750
Mailing Address - Fax:309-752-0755
Practice Address - Street 1:918 16TH AVE
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-2126
Practice Address - Country:US
Practice Address - Phone:309-752-0750
Practice Address - Fax:309-752-0755
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL627400Medicare ID - Type Unspecified
ILT38685Medicare UPIN