=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891961082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRIEDMAN CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2008
-----------------------------------------------------
Last Update Date | 05/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 D ST SUITE 2
-----------------------------------------------------
City | PETALUMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94952-3006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-773-0288
-----------------------------------------------------
Fax | 707-773-0288
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 711 D ST SUITE 104
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94901-3707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-459-4646
-----------------------------------------------------
Fax | 415-459-8003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JEFFREY I FRIEDMAN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 707-773-0288
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 730
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHR3740
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3117
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC11306
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------