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General NPI Number Information
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NPI Number | 1730138165
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Entity Type | Individual
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Provider Name | PAUL WALLER FRIEDMAN D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 1124 SAM RITTENBERG BLVD SUITE #4
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City | CHARLESTON
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State | SC
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Zip | 29407-3362
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Country | US
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Telephone | 843-225-2588
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Fax | 843-225-2599
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Provider Business Mailing Address
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Address Line | 1505 FROGLEG CT
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City | MT PLEASANT
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State | SC
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Zip | 29466-9160
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Country | US
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Telephone | 843-270-2286
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Fax | 843-225-2599
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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 | 2136
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License Number State | SC
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