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General NPI Number Information
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NPI Number | 1154208825
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Entity Type | Organization
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Legal Business Name | FREEDOM CHIROPRACTIC AND REHABILITATION LLC
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Dates
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Enumeration Date | 08/16/2025
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Last Update Date | 08/16/2025
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Provider Practice Location Address
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Address Line | 158 EGLIN PKWY NE STE 109B
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4402
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Country | US
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Telephone | 515-858-6772
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Fax |
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Provider Business Mailing Address
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Address Line | 251 COUNTRY CLUB RD
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City | SHALIMAR
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State | FL
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Zip | 32579-2218
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Country | US
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Telephone | 515-858-6772
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Fax |
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Authorized Official
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Title or Position | OWNER/ CHIROPRACTOR
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Name | DYLAN M SMITH
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Credential | DC
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Telephone | 515-858-6772
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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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