Healthcare Provider Details

I. General information

NPI: 1003153586
Provider Name (Legal Business Name): FREEHOLD SPINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PROFESSIONAL VIEW DRIVE SUITE 103
FREEHOLD NJ
07728-2526
US

IV. Provider business mailing address

100 PROFESSIONAL VIEW DRIVE SUITE 103
FREEHOLD NJ
07728-2526
US

V. Phone/Fax

Practice location:
  • Phone: 732-431-6674
  • Fax:
Mailing address:
  • Phone: 732-431-6674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD RYAN
Title or Position: CHIROPRACTPR
Credential: D.C
Phone: 732-780-2273