Provider Demographics
NPI:1336349034
Name:ERB CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ERB CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:ERB
Authorized Official - Suffix:
Authorized Official - Credentials:LLC
Authorized Official - Phone:715-235-3810
Mailing Address - Street 1:1802 TALEN ST
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-1474
Mailing Address - Country:US
Mailing Address - Phone:715-235-3810
Mailing Address - Fax:
Practice Address - Street 1:1802 TALEN ST
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-1474
Practice Address - Country:US
Practice Address - Phone:715-235-3810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI19075Medicare PIN