Organization
EDGE CHIROPRACTIC & WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ZACHARY DANIEL FRERE D.C. (MANAGER)
(618) 448-0220
Entity
Organization
Contact information
Practice address
111 E CHURCH ST, MASCOUTAH, IL 62258-2110
(618) 448-0220
Mailing address
111 E CHURCH ST, MASCOUTAH, IL 62258-2110
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038011205
IL
Other
Enumeration date
07/24/2009
Last updated
10/22/2009
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