Provider Demographics
NPI:1255504544
Name:TERRANCE E. ERDMAN D.C, P.C.
Entity Type:Organization
Organization Name:TERRANCE E. ERDMAN D.C, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:ERDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PC
Authorized Official - Phone:503-620-4880
Mailing Address - Street 1:12405 SW MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6109
Mailing Address - Country:US
Mailing Address - Phone:503-620-4880
Mailing Address - Fax:503-620-4886
Practice Address - Street 1:12405 SW MAIN ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6109
Practice Address - Country:US
Practice Address - Phone:503-620-4880
Practice Address - Fax:503-620-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORROOOOQGBHSMedicare PIN