Provider Demographics
NPI:1396743613
Name:FRIEDMAN, SETH MARK (DC)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:MARK
Last Name:FRIEDMAN
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 1:406 LINDA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1630
Mailing Address - Country:US
Mailing Address - Phone:505-982-1135
Mailing Address - Fax:505-986-0026
Practice Address - Street 1:406 LINDA VISTA RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1630
Practice Address - Country:US
Practice Address - Phone:505-982-1135
Practice Address - Fax:505-986-0026
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM$$$$$$$$$Medicare UPIN