Healthcare Provider Details

I. General information

NPI: 1992181127
Provider Name (Legal Business Name): FREEDOM CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11876 OLIO RD #500
FISHERS IN
46037-9765
US

IV. Provider business mailing address

11876 OLIO RD #500
FISHERS IN
46037-9765
US

V. Phone/Fax

Practice location:
  • Phone: 317-595-9620
  • Fax: 317-595-9630
Mailing address:
  • Phone: 317-595-9620
  • Fax: 317-595-9630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002407A
License Number StateIN

VIII. Authorized Official

Name: DR. DAVID JONATHAN EVANS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 317-508-7127