Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC13313 | CA |
NPI | 1003023839 |
---|---|
Provider Name | Dr. Glenn Barry Frieder |
First Address | Solana Beach, CA 92075-1165 |
Second Address | Solana Beach, CA 92075-1165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 10/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T04968 | (02) | CA |