Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3312 | OH |
N | 207R00000X | Internist | 3312 | OH |
N | 111NI0900X | Internist | 3312 | OH |
N | 111NN0400X | Neurology | 3312 | OH |
N | 111NN1001X | Nutrition | 3312 | OH |
N | 111NR0200X | Radiology | 3312 | OH |
N | 213ER0200X | Radiology | 3312 | OH |
N | 111NR0400X | Rehabilitation Chiropractor | 3312 | OH |
N | 111NS0005X | Chiropractic Sports Physician | 3312 | OH |
N | 111NT0100X | Thermography | 3312 | OH |
N | 111NX0100X | Occupational Health | 3312 | OH |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 3312 | OH |
NPI | 1508924929 |
---|---|
Provider Name | Dr. Jeremiah Ezra Freedman |
First Address | Fairlawn, OH 44333-4510 |
Second Address | Fairlawn, OH 44333-4510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 12/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000314225 | ANTHEM BC BS (01) | OH |
4114841 | (02) | OH |