Provider Demographics
NPI:1255392627
Name:FRIESEN, MITCHELL (DC)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:FRIESEN
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 1:513 W MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2833
Mailing Address - Country:US
Mailing Address - Phone:608-825-8111
Mailing Address - Fax:608-825-8111
Practice Address - Street 1:513 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-2833
Practice Address - Country:US
Practice Address - Phone:608-825-8111
Practice Address - Fax:608-825-8111
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3018-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38875100Medicaid
WI38875100Medicaid