Provider Demographics
NPI:1730183328
Name:FREEMAN, JEFFREY GLENN (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GLENN
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:15478-0360
Mailing Address - Country:US
Mailing Address - Phone:724-569-0777
Mailing Address - Fax:724-569-1688
Practice Address - Street 1:93 MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:PA
Practice Address - Zip Code:15478-8900
Practice Address - Country:US
Practice Address - Phone:724-569-0777
Practice Address - Fax:724-569-1688
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2008-07-09
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
PADC007244L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017962830001Medicaid
PAU75758Medicare UPIN
PA060239Medicare ID - Type Unspecified
PA060239Medicare PIN