Healthcare Provider Details

I. General information

NPI: 1033522263
Provider Name (Legal Business Name): FREEDOM CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 S LINDBERGH BLVD STE 3
SAINT LOUIS MO
63127-1830
US

IV. Provider business mailing address

279 BOWLES AVE
FENTON MO
63026-3921
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-0300
  • Fax: 314-729-1015
Mailing address:
  • Phone: 314-843-0300
  • Fax: 314-729-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number2007030811
License Number StateMO

VIII. Authorized Official

Name: DR. LOVIE NATHAN FREE III
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 314-843-0300