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General NPI Number Information
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NPI Number | 1922432327
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Entity Type | Organization
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Legal Business Name | FREEDOM CHIROPRACTIC CLINIC, INC.
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 113 NICKELS ST
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City | HOT SPRINGS
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State | AR
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Zip | 71901-6443
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Country | US
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Telephone | 501-463-4965
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 645
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City | HOT SPRINGS
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State | AR
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Zip | 71902-0645
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Country | US
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Telephone | 501-463-4965
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KELLY JENNINGS
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Credential | D.C.
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Telephone | 972-849-2634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NP0017X
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Taxonomy Name | Pediatric Chiropractor
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License Number | 16006
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License Number State | AR
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