Provider Demographics
NPI:1972033082
Name:FRIEDERICHS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FRIEDERICHS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRIEDERICHS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-459-8475
Mailing Address - Street 1:604 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3425
Mailing Address - Country:US
Mailing Address - Phone:920-459-8475
Mailing Address - Fax:920-694-0437
Practice Address - Street 1:604 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3425
Practice Address - Country:US
Practice Address - Phone:920-459-8475
Practice Address - Fax:920-694-0437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4742-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty