=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104021229
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAUL W FRIEDMAN DC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1124 SAM RITTENBERG BLVD SUITE #4
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29407-3362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-225-2588
-----------------------------------------------------
Fax | 843-225-2599
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1124 SAM RITTENBERG BLVD SUITE #4
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29407-3362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-225-2588
-----------------------------------------------------
Fax | 843-225-2599
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OWNER
-----------------------------------------------------
Name | DR. PAUL W FRIEDMAN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 843-225-2588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2136
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------