=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427633080
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREITAG FAMILY CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2021
-----------------------------------------------------
Last Update Date | 10/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 W 98TH ST STE 111
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55420-3815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-818-2485
-----------------------------------------------------
Fax | 952-479-9951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 W 98TH ST STE 111
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55420-3815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-818-2485
-----------------------------------------------------
Fax | 952-479-9951
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / CHIROPRACTOR
-----------------------------------------------------
Name | DR. GREGORY MICHAEL FREITAG
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 952-818-2485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------