Provider Demographics
NPI:1205896057
Name:EHRESMAN, CARL EDWARD II (DC)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:EDWARD
Last Name:EHRESMAN
Suffix:II
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 1267
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-1267
Mailing Address - Country:US
Mailing Address - Phone:360-275-4401
Mailing Address - Fax:360-275-8016
Practice Address - Street 1:23160 NE STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9328
Practice Address - Country:US
Practice Address - Phone:360-275-4401
Practice Address - Fax:360-275-8016
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA103823OtherLABOR & INDUSTRIES