Healthcare Provider Details

I. General information

NPI: 1760682827
Provider Name (Legal Business Name): FREEDLUND FAMILY CHIROPRATIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S BENTON STREET
WINNEBAGO IL
61088-8589
US

IV. Provider business mailing address

119 S BENTON STREET
WINNEBAGO IL
61088-8589
US

V. Phone/Fax

Practice location:
  • Phone: 815-335-1381
  • Fax: 815-335-7601
Mailing address:
  • Phone: 815-335-1381
  • Fax: 815-335-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JON S FREEDLUND
Title or Position: OFFICE MANAGER
Credential:
Phone: 815-335-1381