Provider Demographics
NPI:1861417073
Name:FREEDLUND, HEATHER ADELE (DC)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ADELE
Last Name:FREEDLUND
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 1:201 W SOPER ST
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:IL
Mailing Address - Zip Code:61088-8589
Mailing Address - Country:US
Mailing Address - Phone:815-247-9071
Mailing Address - Fax:
Practice Address - Street 1:201 W SOPER ST
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:IL
Practice Address - Zip Code:61088-8589
Practice Address - Country:US
Practice Address - Phone:815-335-1381
Practice Address - Fax:815-335-7601
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212862Medicare ID - Type Unspecified