Provider Demographics
NPI:1801211677
Name:FRIEDEMANN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FRIEDEMANN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FRIEDEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-297-1551
Mailing Address - Street 1:403 KETTLE MORAINE DR S
Mailing Address - Street 2:
Mailing Address - City:SLINGER
Mailing Address - State:WI
Mailing Address - Zip Code:53086-9696
Mailing Address - Country:US
Mailing Address - Phone:262-297-1551
Mailing Address - Fax:262-297-1550
Practice Address - Street 1:403 KETTLE MORAINE DR S
Practice Address - Street 2:
Practice Address - City:SLINGER
Practice Address - State:WI
Practice Address - Zip Code:53086-9696
Practice Address - Country:US
Practice Address - Phone:262-297-1551
Practice Address - Fax:262-297-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU72579Medicare UPIN