Provider Demographics
NPI:1194725986
Name:FRED R LOERTSCHER DC PS
Entity type:Organization
Organization Name:FRED R LOERTSCHER DC PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:RUDOLPH
Authorized Official - Last Name:LOERTSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-532-6545
Mailing Address - Street 1:1310 SIMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-4704
Mailing Address - Country:US
Mailing Address - Phone:360-532-6545
Mailing Address - Fax:360-532-6549
Practice Address - Street 1:1310 SIMPSON AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-4704
Practice Address - Country:US
Practice Address - Phone:360-532-6545
Practice Address - Fax:360-532-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00000853111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALO 0307OtherREGENCE INSURANCE CO
WA2555803Medicaid
WA13278OtherDEPT OF LABOR & INDUSTRIE
WAU21639Medicare UPIN