Healthcare Provider Details

I. General information

NPI: 1891728135
Provider Name (Legal Business Name): FREEDOM CHIROPRACTIC SERVICES MIDWEST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 W ALGONQUIN RD
ALGONQUIN IL
60102-9400
US

IV. Provider business mailing address

620 S MADISON ST
WHITEVILLE NC
28472-4130
US

V. Phone/Fax

Practice location:
  • Phone: 910-641-0425
  • Fax: 910-640-2054
Mailing address:
  • Phone: 910-641-0425
  • Fax: 910-640-2054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberNC1459
License Number StateNC

VIII. Authorized Official

Name: DR. JOHN A. WEBSTER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 910-641-0425