Provider Demographics
NPI:1144371782
Name:LOERTSCHER, FRED RUDOLPH (DC)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:RUDOLPH
Last Name:LOERTSCHER
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 1:1310 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
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00000853111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA13278OtherDEPT OF LABOR AND INDUSTR
WALO0307OtherREGENCE BLUESHIELD
WAU21639Medicare UPIN
WALO0307OtherREGENCE BLUESHIELD