Healthcare Provider Details

I. General information

NPI: 1508925314
Provider Name (Legal Business Name): FREEDMAN CLINIC OF CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3029 SMITH RD SUITE 400
FAIRLAWN OH
44333-3370
US

IV. Provider business mailing address

3029 SMITH RD SUITE 400
FAIRLAWN OH
44333-3370
US

V. Phone/Fax

Practice location:
  • Phone: 330-670-9400
  • Fax: 330-670-9401
Mailing address:
  • Phone: 330-670-9400
  • Fax: 330-670-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3312, 3412
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number3312, 3412
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number3312, 3412
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number3312, 3412
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number3312, 3412
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3312, 3412
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3312, 3412
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number3312, 3412
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number3312, 3412
License Number StateOH
# 10
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT-9434
License Number StateOH
# 11
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number3312, 3412
License Number StateOH

VIII. Authorized Official

Name: DR. DEANNA M FREEDMAN
Title or Position: ADMINISTRATOR
Credential: D.C.
Phone: 330-670-9400