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General NPI Number Information
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NPI Number | 1073394797
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Entity Type | Organization
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Legal Business Name | FREEDOM CHIROPRACTIC LLC
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 10981 4TH ST NE STE 106
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City | HANOVER
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State | MN
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Zip | 55341-4092
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Country | US
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Telephone | 763-568-2412
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Fax |
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Provider Business Mailing Address
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Address Line | 10981 4TH ST NE STE 106
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City | HANOVER
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State | MN
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Zip | 55341-4092
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Country | US
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Telephone | 763-568-2412
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TYLER EDIGER
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Credential | DC
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Telephone | 316-641-4911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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