Provider Demographics
NPI:1083766364
Name:DAVID R. FRIEDMAN DC PA
Entity Type:Organization
Organization Name:DAVID R. FRIEDMAN DC PA
Other - Org Name:FRIEDMAN CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-350-2664
Mailing Address - Street 1:1033 S KERR AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4312
Mailing Address - Country:US
Mailing Address - Phone:910-350-2664
Mailing Address - Fax:910-350-0632
Practice Address - Street 1:1033 S KERR AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4312
Practice Address - Country:US
Practice Address - Phone:910-350-2664
Practice Address - Fax:910-350-0632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890824XMedicaid
NC0824XOtherBCBS
NC330587OtherACN
NC330587OtherACN
NC890824XMedicaid