Provider Demographics
NPI:1891961082
Name:FRIEDMAN CHIROPRACTIC INC
Entity Type:Organization
Organization Name:FRIEDMAN CHIROPRACTIC INC
Other - Org Name:FRIEDMAN CHIROPRACTIC CENTER INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:I
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-773-0288
Mailing Address - Street 1:711 D ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3707
Mailing Address - Country:US
Mailing Address - Phone:415-459-4646
Mailing Address - Fax:415-459-8003
Practice Address - Street 1:405 D ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3006
Practice Address - Country:US
Practice Address - Phone:707-773-0288
Practice Address - Fax:707-773-0288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11306111N00000X
NM730111N00000X
COCHR3740111N00000X
AZ3117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06614ZMedicare PIN