Provider Demographics
NPI:1295939247
Name:ERDMAN, TERRANCE E (DC)
Entity type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:E
Last Name:ERDMAN
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 1:12405 SW MAIN STREET
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 STREET
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
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR911751062OtherFEDERAL TAX ID NUMBER
OR0000QGBHSMedicare ID - Type UnspecifiedMEDICARE ID NUMBER