Provider Demographics
NPI:1730138165
Name:FRIEDMAN, PAUL WALLER (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WALLER
Last Name:FRIEDMAN
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 1:1505 FROGLEG CT
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9160
Mailing Address - Country:US
Mailing Address - Phone:843-270-2286
Mailing Address - Fax:843-225-2599
Practice Address - Street 1:1124 SAM RITTENBERG BLVD
Practice Address - Street 2:SUITE #4
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3362
Practice Address - Country:US
Practice Address - Phone:843-225-2588
Practice Address - Fax:843-225-2599
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2136Medicaid
SCU6525Medicare UPIN