Provider Demographics
NPI:1407927635
Name:FRIEDEMANN, THOMAS J (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:FRIEDEMANN
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 1:128 KETTLE MORAINE DR S
Mailing Address - Street 2:
Mailing Address - City:SLINGER
Mailing Address - State:WI
Mailing Address - Zip Code:53086-9702
Mailing Address - Country:US
Mailing Address - Phone:262-291-1551
Mailing Address - Fax:262-297-1550
Practice Address - Street 1:128 KETTLE MORAINE DR S
Practice Address - Street 2:
Practice Address - City:SLINGER
Practice Address - State:WI
Practice Address - Zip Code:53086-9702
Practice Address - Country:US
Practice Address - Phone:262-291-1551
Practice Address - Fax:262-297-1550
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3468-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00229736OtherRAILROAD MEDICARE
WI38908300Medicaid
WIU72579Medicare UPIN
WI38908300Medicaid