Provider Demographics
NPI:1558396242
Name:FRIEDLY, HOWARD W (DC)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:W
Last Name:FRIEDLY
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:PO BOX 5859
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98509
Mailing Address - Country:US
Mailing Address - Phone:360-438-1998
Mailing Address - Fax:360-438-3524
Practice Address - Street 1:4444 LACEY BLVD SE STE E
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5730
Practice Address - Country:US
Practice Address - Phone:360-438-1998
Practice Address - Fax:360-438-3524
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001743111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT02703Medicare UPIN
WAG8866580Medicare PIN