=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205997871
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KERI FRESHOUR DC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 04/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 379 W UWCHLAN AVE STE 100
-----------------------------------------------------
City | DOWNINGTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19335-3168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-873-9610
-----------------------------------------------------
Fax | 610-873-9670
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 379 W UWCHLAN AVE STE 100
-----------------------------------------------------
City | DOWNINGTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19335-3168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-873-9610
-----------------------------------------------------
Fax | 610-873-9670
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KERI LYNNE FRESHOUR
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 610-873-9610
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC-005872-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------