Provider Demographics
NPI:1043436355
Name:AMY B FRIEDMAN CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:AMY B FRIEDMAN CHIROPRACTIC CORPORATION
Other - Org Name:AMY B FRIEDMAN CHIROPRACTIC CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-832-8747
Mailing Address - Street 1:165 YORBA ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2924
Mailing Address - Country:US
Mailing Address - Phone:714-832-8747
Mailing Address - Fax:866-572-2498
Practice Address - Street 1:165 YORBA ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2924
Practice Address - Country:US
Practice Address - Phone:714-832-8747
Practice Address - Fax:866-572-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15795Medicare ID - Type Unspecified