Provider Demographics
NPI:1922230879
Name:LIEBERKNECHT, ERICH CLAIR (DC)
Entity Type:Individual
Prefix:DR
First Name:ERICH
Middle Name:CLAIR
Last Name:LIEBERKNECHT
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 1:4636 SE CENTER ST
Mailing Address - Street 2:STE. A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3292
Mailing Address - Country:US
Mailing Address - Phone:503-757-4846
Mailing Address - Fax:
Practice Address - Street 1:4636 SE CENTER ST
Practice Address - Street 2:STE. A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-3292
Practice Address - Country:US
Practice Address - Phone:503-757-4846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor