Provider Demographics
NPI:1013188853
Name:ERSCHABEK CHIROPRACTIC
Entity Type:Organization
Organization Name:ERSCHABEK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ERSCHABEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-532-5111
Mailing Address - Street 1:2039 E A ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-2825
Mailing Address - Country:US
Mailing Address - Phone:307-532-5111
Mailing Address - Fax:307-532-2538
Practice Address - Street 1:2039 E A ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-2825
Practice Address - Country:US
Practice Address - Phone:307-532-5111
Practice Address - Fax:307-532-2538
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERSCHABEK CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW10185Medicare PIN
WYT90542Medicare UPIN