MEDICARE: DR. AGNES REGINA FREEMAN D.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3092	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	085H6	OTHER	NC	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083616825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AGNES REGINA FREEMAN D.C

Provider Business Mailing Address
First Line	:	1424 S JK POWELL BLVD STE D
Second Line	:
City	:	WHITEVILLE
State	:	NC
Zip	:	28472-9145
Country	:	US
Telephone Number	:	910-642-1111
Fax Number	:	910-642-0111

Provider Business Practice Location Address
First Line	:	1424 S JK POWELL BLVD STE D
Second Line	:
City	:	WHITEVILLE
State	:	NC
Zip	:	28472-9145
Country	:	US
Telephone Number	:	910-642-1111
Fax Number	:	910-642-0111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	12/28/2023

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