Individual provider Active NPI

Dustin Ezra Fread, D.C.

  • Chiropractor
  • Kearney, NE
National Provider Identifier
1417267279
Registry record updated Oct 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1632 Issued in NE
Practice address
5308 Parklane Dr
#5
Kearney, NE 68847-8630
Phone
(308) 237-0648
Fax
(308) 236-9197
NPI assigned
Oct 14, 2010
Last updated
Oct 14, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 14, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1632 NE Primary

Addresses

Primary practice location

5308 Parklane Dr
#5
Kearney, NE 68847-8630

Mailing address

5308 Parklane Dr
#5
Kearney, NE 68847-8630

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101018001223 NE Practitioner - Chiropractic 5193918506 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2010
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

220 A W 42ND St
Kearney, NE 68845-8500
Phone (308) 237-0648

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1632NEMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Ihle Family Chiropractic, P.C. Chiropractor CurrentSince Nov 5, 2023 Accepting new patients
Fread Family Chiropractic, P.C. Chiropractor CurrentSince Dec 9, 2010 Accepting new patients

Locations

220 W 42nd St
#A
Kearney, NE 68845
Phone (308) 237-0648

220 W 42nd St
Unit A
Kearney, NE 68845

5308 Parklane Dr
Ste 5
Kearney, NE 68847
Phone (308) 251-2222

Organizations & group practices 2

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": "1287014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287014400000",
    "number": "1417267279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5308 PARKLANE DR",
            "address_2": "#5",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688478630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5308 PARKLANE DR",
            "address_2": "#5",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688478630",
            "telephone_number": "308-237-0648",
            "fax_number": "308-236-9197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREAD",
        "first_name": "DUSTIN",
        "middle_name": "EZRA",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-14",
        "last_updated": "2010-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NE",
            "license": "1632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kearney, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2010; 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.