Provider Demographics
NPI:1700527975
Name:FRIED, EMILY (DC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:FRIED
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13702 SW HALL BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8155
Mailing Address - Country:US
Mailing Address - Phone:203-417-1613
Mailing Address - Fax:
Practice Address - Street 1:9455 SW 80TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8966
Practice Address - Country:US
Practice Address - Phone:503-662-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-04
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor