=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356468250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANS FREERICKS CHIROPRACTIC CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 02/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39284 PASEO PADRE PKWY
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-1616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-797-4796
-----------------------------------------------------
Fax | 510-573-6316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39284 PASEO PADRE PKWY
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-1616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-797-4796
-----------------------------------------------------
Fax | 510-573-6316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. HANS FREERICKS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 510-797-4796
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC23807
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------