Organization Active NPI

Stewart B. Fresh, DC, LLC

  • Chiropractor
  • Covington, LA
National Provider Identifier
1063718138
Registry record updated Dec 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1405 Issued in LA
Legal business name
STEWART B. FRESH, DC, LLC
Practice address
9 Starbrush Cir
Suite 201
Covington, LA 70433-7246
Phone
(985) 259-7774
Fax
(985) 259-7775
NPI assigned
Feb 7, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Stewart B Fresh, D.C.NPI 1710921671
Title
Owner
Phone
(985) 259-7774

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 1405 LA Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X

Addresses

Primary practice location

9 Starbrush Cir
Suite 201
Covington, LA 70433-7246

Mailing address

9 Starbrush Cir
Suite 201
Covington, LA 70433-7246
Phone (985) 259-7774

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110208000634 LA Part B Supplier - Clinic/Group Practice 6305026378 Receives reassigned benefits from 2 practitioners
Practice locations: Covington, LA; Mandeville, LA

National Provider Directory

National Provider Directory

Locations

9 Starbrush Cir
Covington, LA 70433

2480 N Causeway Blvd
Mandeville, LA 70471
Phone (985) 634-1112

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387756800000",
    "number": "1063718138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 STARBRUSH CIR",
            "address_2": "SUITE 201",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704337246",
            "telephone_number": "985-259-7774",
            "fax_number": "985-259-7775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 STARBRUSH CIR",
            "address_2": "SUITE 201",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704337246",
            "telephone_number": "985-259-7774",
            "fax_number": "985-259-7775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEWART B. FRESH, DC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-07",
        "last_updated": "2013-12-23",
        "status": "A",
        "authorized_official_last_name": "FRESH",
        "authorized_official_first_name": "STEWART",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-259-7774",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "LA",
            "license": "1405",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.