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General NPI Number Information
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NPI Number | 1689963472
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Entity Type | Individual
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Provider Name | KYLE JAMES FRIEDERICHS DC
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Gender | Male
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 09/19/2011
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Provider Practice Location Address
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Address Line | 620 MICHIGAN AVE
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City | SHEBOYGAN
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State | WI
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Zip | 53081-3042
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Country | US
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Telephone | 920-459-8475
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Fax |
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Provider Business Mailing Address
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Address Line | 1002 DREIFUERST RD
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City | PLYMOUTH
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State | WI
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Zip | 53073-1422
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Country | US
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Telephone | 920-627-0901
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 474212
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License Number State | WI
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