MEDICARE: D & D FREEDOM PSC

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	4469	KY

General Provider Information

NPI Number	:	1225050719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D & D FREEDOM PSC

Provider Business Mailing Address
First Line	:	60 STONECREST CT
Second Line	:	SUITE 140
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8155
Country	:	US
Telephone Number	:	502-647-4600
Fax Number	:	502-647-4607

Provider Business Practice Location Address
First Line	:	60 STONECREST CT
Second Line	:	SUITE 140
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8155
Country	:	US
Telephone Number	:	502-647-4600
Fax Number	:	502-647-4607

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. DIANA M COLE
Credential	:	DC
Telephone Number	:	502-647-4600

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	10/25/2007

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Directions to “D & D FREEDOM PSC ” Practice Location

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