Provider Demographics
NPI:1477628683
Name:FRIEND, PATRICK JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOHN
Last Name:FRIEND
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 1:3525 N 147TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-8262
Mailing Address - Country:US
Mailing Address - Phone:402-491-4087
Mailing Address - Fax:402-491-4091
Practice Address - Street 1:3525 N 147TH ST STE 205
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-8262
Practice Address - Country:US
Practice Address - Phone:402-491-4087
Practice Address - Fax:402-491-4091
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36607OtherBLUE CROSS BLUE SHIELD
NE47081359900Medicaid
NE270993Medicare ID - Type Unspecified
NE47081359900Medicaid