Provider Demographics
NPI:1265497762
Name:FRIEDMAN, AMY BETH (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:BETH
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15795Medicare UPIN