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General NPI Number Information
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NPI Number | 1265892913
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Entity Type | Organization
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Legal Business Name | FREEDOM CHIROPRACTIC
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 5675 WATERMAN BLVD APT 11
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City | SAINT LOUIS
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State | MO
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Zip | 63112-1815
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Country | US
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Telephone | 703-231-4609
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Fax |
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Provider Business Mailing Address
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Address Line | 5675 WATERMAN BLVD APT 11
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City | SAINT LOUIS
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State | MO
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Zip | 63112-1815
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBET KELLY
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Credential | DC
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Telephone | 703-231-4609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 2015028621
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License Number State | MO
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