NPIMap

Individual provider Active NPI

Zachary Daniel Frere, D.C.

  • Chiropractor
  • Mascoutah, IL
National Provider Identifier
1891974127
Registry record updated Oct 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038011205 Issued in IL
Practice address
111 E Church St
Mascoutah, IL 62258-2110
Phone
(618) 448-0220
NPI assigned
Nov 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 6152 CO
Chiropractor 111N00000X 038011205 IL Primary

Addresses

Primary practice location

111 E Church St
Mascoutah, IL 62258-2110

Mailing address

111 E Church St
Mascoutah, IL 62258-2110
Phone (618) 448-0220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6152COMDChiropractor
038011205ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Edge Chiropractic & Wellness LLC Chiropractor PastSince Apr 30, 2003 Accepting new patients
Norris Rehab Clinic Chiropractor Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1193961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256169600000",
    "number": "1891974127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E CHURCH ST",
            "city": "MASCOUTAH",
            "state": "IL",
            "postal_code": "622582110",
            "telephone_number": "618-448-0220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E CHURCH ST",
            "city": "MASCOUTAH",
            "state": "IL",
            "postal_code": "622582110",
            "telephone_number": "618-448-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRERE",
        "first_name": "ZACHARY",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-02",
        "last_updated": "2009-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CO",
            "license": "6152",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038011205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mascoutah, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.