Provider Demographics
NPI:1932136546
Name:FRIEDMANN, KEITH ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALLEN
Last Name:FRIEDMANN
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 318
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:IA
Mailing Address - Zip Code:52052-0318
Mailing Address - Country:US
Mailing Address - Phone:563-252-3507
Mailing Address - Fax:563-252-1254
Practice Address - Street 1:815 S HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:IA
Practice Address - Zip Code:52052-9018
Practice Address - Country:US
Practice Address - Phone:563-252-3507
Practice Address - Fax:563-252-1254
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06594111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA34628OtherBLUE CROSS BLUE SHIELD
IAP00115113OtherMEDICARE RAILROAD CARRIER
IA0415075Medicaid
IA432007215OtherMEDICAL ASSOCIATES (HMO)
IA34628OtherBLUE CROSS BLUE SHIELD