Provider Demographics
NPI:1033100102
Name:FRIEDERS, JUSTIN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JAMES
Last Name:FRIEDERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 CARMEL DR
Mailing Address - Street 2:UNIT 101
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4275
Mailing Address - Country:US
Mailing Address - Phone:925-952-4734
Mailing Address - Fax:
Practice Address - Street 1:3333 VINCENT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4309
Practice Address - Country:US
Practice Address - Phone:925-946-9355
Practice Address - Fax:925-946-9377
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-28372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC-0283720Medicare ID - Type Unspecified
CAU94745Medicare UPIN