Provider Demographics
NPI:1275509812
Name:FRIEDMAN, DEREK M (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:M
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 1:1227 W LIBERTY ST STE 204
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-2604
Mailing Address - Country:US
Mailing Address - Phone:610-351-9555
Mailing Address - Fax:
Practice Address - Street 1:1227 W LIBERTY ST STE 204
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-2604
Practice Address - Country:US
Practice Address - Phone:610-351-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7543111N00000X
PADC011299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU82742Medicare UPIN
FL558942Medicare ID - Type Unspecified