MEDICARE: FREEDOM FAMILY CHIROPRACTIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1134960131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM FAMILY CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	24520 S US HIGHWAY 52
Second Line	:
City	:	MANHATTAN
State	:	IL
Zip	:	60442-7784
Country	:	US
Telephone Number	:	815-474-4151
Fax Number	:

Provider Business Practice Location Address
First Line	:	24520 S US HIGHWAY 52
Second Line	:
City	:	MANHATTAN
State	:	IL
Zip	:	60442-7784
Country	:	US
Telephone Number	:	815-474-4151
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JUSTINE JOHNSON
Credential	:	DC
Telephone Number	:	815-478-4151

Provider Enumeration Date	:	06/04/2024
Last Update Date	:	06/04/2024

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