Individual provider Active NPI

Agnes Regina Freeman, D.C

  • Chiropractor
  • Whiteville, NC
National Provider Identifier
1083616825
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3092 Issued in NC
Practice address
1424 S JK Powell Blvd Ste D
Whiteville, NC 28472-9145
Phone
(910) 642-1111
Fax
(910) 642-0111
NPI assigned
Aug 11, 2005
Last updated
Dec 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3092 NC Primary

Addresses

Primary practice location

1424 S JK Powell Blvd Ste D
Whiteville, NC 28472-9145

Mailing address

1424 S JK Powell Blvd Ste D
Whiteville, NC 28472-9145
Phone (910) 642-1111

Other identifiers 2

IdentifierTypeStateIssuer
89085H6MedicaidNC
085H6OtherNCBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080521000108 NC Practitioner - Chiropractic 9335218098 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College - West, 2001
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1424 S JK Powell Blvd
Suite D
Whiteville, NC 28472-9145
Phone (910) 642-1111

4465 Main St
Shallotte, NC 28470-4451
Phone (910) 505-8680

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3092NCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Shallotte Chiropractic Balance and Wellness PLLC Chiropractor CurrentSince Oct 14, 2023 Accepting new patients
Freeman Chiropractic Wellness Center Chiropractor CurrentSince Feb 3, 2020 Accepting new patients
Southeastern Healthcare Centers PC Chiropractor Current Accepting new patients
Southeastern Healthcare Centers PC Chiropractor CurrentSince Jun 1, 2008 Accepting new patients
Southeastern Healthcare Center PC Chiropractor CurrentSince Jun 1, 2008 Accepting new patients
Port City Chiropractic Inc. Chiropractor Past Accepting new patients
Whiteville Chiropractic Center, PA Chiropractor PastSince Feb 3, 2020 Accepting new patients

Locations

4465 Main St
Shallotte, NC 28470
Phone (910) 505-8680

1424 S Jk Powell Blvd
Ste D
Whiteville, NC 28472
Phone (910) 642-1111

2595 S 17th St
Wilmington, NC 28401
Phone (910) 392-1252

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1083616825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1424 S JK POWELL BLVD STE D",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284729145",
            "telephone_number": "910-642-1111",
            "fax_number": "910-642-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1424 S JK POWELL BLVD STE D",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284729145",
            "telephone_number": "910-642-1111",
            "fax_number": "910-642-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREEMAN",
        "first_name": "AGNES",
        "middle_name": "REGINA",
        "name_prefix": "Dr.",
        "credential": "D.C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-11",
        "last_updated": "2023-12-28",
        "certification_date": "2023-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "3092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89085H6",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "085H6",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whiteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.