Healthcare Provider Details

I. General information

NPI: 1831458082
Provider Name (Legal Business Name): TREVOR EUGENE EIRICH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 MAIN ST
BAYARD NE
69334
US

IV. Provider business mailing address

PO BOX 90
BAYARD NE
69334-0090
US

V. Phone/Fax

Practice location:
  • Phone: 308-631-2489
  • Fax:
Mailing address:
  • Phone: 308-631-2489
  • Fax: 308-586-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1719
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: