Provider Demographics
NPI:1205284106
Name:SELECT MED LLC
Entity type:Organization
Organization Name:SELECT MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:ERDMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-677-4800
Mailing Address - Street 1:21321 E OCOTILLO RD
Mailing Address - Street 2:STE 125
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5996
Mailing Address - Country:US
Mailing Address - Phone:480-677-4800
Mailing Address - Fax:480-436-6667
Practice Address - Street 1:21321 E OCOTILLO RD
Practice Address - Street 2:STE 125
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5996
Practice Address - Country:US
Practice Address - Phone:480-677-4800
Practice Address - Fax:480-436-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty