Provider Demographics
NPI:1295860906
Name:DR ROBERT J FRIEDRICHS PC
Entity Type:Organization
Organization Name:DR ROBERT J FRIEDRICHS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBY
Authorized Official - Middle Name:K
Authorized Official - Last Name:FRIEDRICHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-424-5415
Mailing Address - Street 1:PO BOX 1155
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50402-1155
Mailing Address - Country:US
Mailing Address - Phone:641-424-5415
Mailing Address - Fax:641-421-2014
Practice Address - Street 1:940 N TYLER AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1840
Practice Address - Country:US
Practice Address - Phone:641-424-5415
Practice Address - Fax:641-421-2014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02204843111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0419283Medicaid
IA19106OtherWELLMARK
IA19106OtherWELLMARK
IA10952Medicare PIN
IA19106OtherWELLMARK