Provider Demographics
NPI:1831458082
Name:EIRICH, TREVOR EUGENE (DC)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:EUGENE
Last Name:EIRICH
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:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:BAYARD
Mailing Address - State:NE
Mailing Address - Zip Code:69334-0090
Mailing Address - Country:US
Mailing Address - Phone:308-631-2489
Mailing Address - Fax:308-586-1082
Practice Address - Street 1:441 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAYARD
Practice Address - State:NE
Practice Address - Zip Code:69334
Practice Address - Country:US
Practice Address - Phone:308-631-2489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor