Healthcare Provider Details

I. General information

NPI: 1932136546
Provider Name (Legal Business Name): KEITH ALLEN FRIEDMANN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S HIGHWAY 52
GUTTENBERG IA
52052-9018
US

IV. Provider business mailing address

PO BOX 318
GUTTENBERG IA
52052-0318
US

V. Phone/Fax

Practice location:
  • Phone: 563-252-3507
  • Fax: 563-252-1254
Mailing address:
  • Phone: 563-252-3507
  • Fax: 563-252-1254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number06594
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: