Provider Demographics
NPI:1477520385
Name:FRIESNER, GREGORY WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WILLIAM
Last Name:FRIESNER
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 1:2804 S OLD ORCHARD CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4339
Mailing Address - Country:US
Mailing Address - Phone:605-334-4722
Mailing Address - Fax:605-330-0889
Practice Address - Street 1:3909 S SOUTHEASTERN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-7186
Practice Address - Country:US
Practice Address - Phone:605-334-4722
Practice Address - Fax:605-330-0889
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD685111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0086551OtherBLUE CROSS BLUE SHIELD
SD7602640Medicaid
SD0086551OtherBLUE CROSS BLUE SHIELD
SD7602640Medicaid