Provider Demographics
NPI:1588726061
Name:ERSCHABEK, JERRY L (DC)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:L
Last Name:ERSCHABEK
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 1:2810 W B ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-1940
Mailing Address - Country:US
Mailing Address - Phone:307-532-5111
Mailing Address - Fax:307-532-2538
Practice Address - Street 1:2810 W B ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-1940
Practice Address - Country:US
Practice Address - Phone:307-532-5111
Practice Address - Fax:307-532-2538
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW10185Medicare ID - Type Unspecified
WYT90542Medicare UPIN