Provider Demographics
NPI:1083833420
Name:FRIEDMAN, JEFFREY I (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:I
Last Name:FRIEDMAN
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 1:711 D ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3703
Mailing Address - Country:US
Mailing Address - Phone:415-459-4646
Mailing Address - Fax:415-459-8003
Practice Address - Street 1:711 D ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3703
Practice Address - Country:US
Practice Address - Phone:415-459-4646
Practice Address - Fax:415-459-8003
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2008-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11306111N00000X
NM730111N00000X
COCHR3740111N00000X
AZ3117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0113060OtherBLUE SHIELD OF CA
CADC0113061OtherBLUE SHIELD OF CA
CA350053730Medicare ID - Type UnspecifiedPALMETTO GBA RR MEDICARE
CADC0113063Medicare PIN
CADC0113062Medicare PIN
CAT04282Medicare UPIN
CA350053729Medicare ID - Type UnspecifiedPALMETTO GBA RR MEDICARE