Provider Demographics
NPI:1891774493
Name:ERHARDT, RUSSELL W (DC)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:W
Last Name:ERHARDT
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 1:9460 W PEORIA AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345
Mailing Address - Country:US
Mailing Address - Phone:623-878-8888
Mailing Address - Fax:623-776-3257
Practice Address - Street 1:9460 W PEORIA AVE
Practice Address - Street 2:SUITE F
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345
Practice Address - Country:US
Practice Address - Phone:623-878-8888
Practice Address - Fax:623-776-3257
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0944090OtherBLUE CROSS BLUE SHIELD AZ
AZZ103142Medicare ID - Type Unspecified