Provider Demographics
NPI:1841212123
Name:FRIDAY, CLINTON ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:ROBERT
Last Name:FRIDAY
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 1:2065 ARNOLD WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-3850
Mailing Address - Country:US
Mailing Address - Phone:619-445-6221
Mailing Address - Fax:619-445-6223
Practice Address - Street 1:2065 ARNOLD WAY STE 101
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-3850
Practice Address - Country:US
Practice Address - Phone:619-445-6221
Practice Address - Fax:619-445-6223
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT17974Medicare UPIN