Freeport Family Chiropractic Clinic LLC
Organization Active NPI Chiropractor · Freeport, FL
NPI 1992902100 · NPPES record last updated Feb 20, 2008
Key facts
- NPI
- 1992902100
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- CH8844 (FL)
- Legal business name
- FREEPORT FAMILY CHIROPRACTIC CLINIC LLC
- Practice address
- 40 Washington St.
Freeport, FL 32439 - Phone
- (850) 835-9867
- Fax
- (850) 880-6089
- NPI assigned
- Jun 29, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Jennifer Logan Laird, D.C
- Title
- Owner
- Phone
- (850) 835-9867
Practitioners 1
-
Jennifer Logan Laird, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070802000562 | FL | Part B Supplier - Clinic/Group Practice | 9739289414 |
Receives reassigned benefits from 1 practitioner Practice locations: Freeport, FL |
National Provider Directory
Locations
40 Washington St
Freeport, FL 32439
Phone (850) 333-0312
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | CH8844 | FL | Yes |
Addresses
Primary practice location
40 Washington St.
Freeport, FL 32439
Mailing address
40 Washington St.
Freeport, FL 32439
Phone (850) 835-9867
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 76145 | Other | FL | BCBS |
Other providers in Freeport, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.