Mark David Frideres, D.C.
Individual provider Active NPI Chiropractor · Nevada, IA
NPI 1013912955 · NPPES record last updated Aug 17, 2012
Key facts
- NPI
- 1013912955
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 06327 (IA)
- Practice address
- 1229 S G Ave
Nevada, IA 50201-2778 - Phone
- (515) 382-2128
- Fax
- (515) 382-3617
- NPI assigned
- Jun 16, 2005
- Reactivated
- Apr 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1229 S G Ave
BLDG B
Nevada, IA 50201-2778
1229 S G Ave BLDG B
Nevada, IA 50201-2778
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050614000645 | IA | Practitioner - Chiropractic | 0648214353 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06327 | IA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frideres Chiropractic Clinic P.C. | Chiropractor | Current |
Accepting new patients |
Locations
1229 S G Ave
Bldg B
Nevada, IA 50201
Phone (515) 382-2128
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 06327 | IA | Yes |
Addresses
Primary practice location
1229 S G Ave
Nevada, IA 50201-2778
Mailing address
1229 S G Ave
Nevada, IA 50201-2778
Phone (515) 382-2128
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0221424 | Medicaid | IA |
Other providers in Nevada, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.