Provider Demographics
NPI:1861402349
Name:FRESHOUR, KERI LYNNE (DC)
Entity type:Individual
Prefix:DR
First Name:KERI
Middle Name:LYNNE
Last Name:FRESHOUR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHADESTONE DR
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-8572
Mailing Address - Country:US
Mailing Address - Phone:610-469-1834
Mailing Address - Fax:
Practice Address - Street 1:379 W UWCHLAN AVE
Practice Address - Street 2:STE 100
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3168
Practice Address - Country:US
Practice Address - Phone:610-873-9610
Practice Address - Fax:610-873-9670
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDDC-005872-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23-2902783OtherEIN