Healthcare Provider Details

I. General information

NPI: 1992902100
Provider Name (Legal Business Name): FREEPORT FAMILY CHIROPRACTIC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WASHINGTON ST.
FREEPORT FL
32439
US

IV. Provider business mailing address

40 WASHINGTON ST.
FREEPORT FL
32439
US

V. Phone/Fax

Practice location:
  • Phone: 850-835-9867
  • Fax: 850-880-6089
Mailing address:
  • Phone: 850-835-9867
  • Fax: 850-880-6089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8844
License Number StateFL

VIII. Authorized Official

Name: DR. JENNIFER LOGAN LAIRD
Title or Position: OWNER
Credential: D.C
Phone: 850-835-9867