Provider Demographics
NPI:1104849306
Name:FRIEDMAN, DAVID R (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
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 1:1033 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
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0824XOtherBCBS
NC890824XMedicaid
NC330587OtherACN
NC2447537Medicare ID - Type Unspecified
NC890824XMedicaid