Provider Demographics
NPI:1538391396
Name:ERICH LIEBERKNECHT LLC
Entity type:Organization
Organization Name:ERICH LIEBERKNECHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:CLAIR
Authorized Official - Last Name:LIEBERKNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-757-4846
Mailing Address - Street 1:4636 SE CENTER ST
Mailing Address - Street 2:STE. A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3292
Mailing Address - Country:US
Mailing Address - Phone:503-757-4846
Mailing Address - Fax:
Practice Address - Street 1:4636 SE CENTER ST
Practice Address - Street 2:STE. A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-3292
Practice Address - Country:US
Practice Address - Phone:503-757-4846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty