MEDICARE: MS. JILL MARIE FRIEDRICHS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5081	MN

General Provider Information

NPI Number	:	1912185448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL MARIE FRIEDRICHS D.C.

Provider Business Mailing Address
First Line	:	4886 HIGHWAY 61 N STE 201
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-2859
Country	:	US
Telephone Number	:	651-762-4757
Fax Number	:

Provider Business Practice Location Address
First Line	:	4886 HIGHWAY 61 N STE 201
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-2859
Country	:	US
Telephone Number	:	651-762-4757
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	11/06/2019

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