Provider Demographics
NPI:1225012768
Name:LOBERG, ERIC RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:RYAN
Last Name:LOBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9455 35TH AVE SW
Mailing Address - Street 2:SUITE E
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3898
Mailing Address - Country:US
Mailing Address - Phone:206-932-8320
Mailing Address - Fax:206-932-6941
Practice Address - Street 1:9455 35TH AVE SW
Practice Address - Street 2:SUITE E
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3898
Practice Address - Country:US
Practice Address - Phone:206-932-8320
Practice Address - Fax:206-932-6941
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA215865OtherLABOR & INDUSTRIES
WA5711LOOtherREGENCE BLUE SHIELD
WA614143800OtherOWCP
WA1457490542OtherGROUP NPI
WAG8863268Medicare PIN
WA215865OtherLABOR & INDUSTRIES
WA614143800OtherOWCP