Provider Demographics
NPI:1013217819
Name:ERIKSEN CHIROPRACTIC OF ELIZABETHTOWN, PLLC
Entity Type:Organization
Organization Name:ERIKSEN CHIROPRACTIC OF ELIZABETHTOWN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ERIKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-737-7597
Mailing Address - Street 1:415 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2769
Mailing Address - Country:US
Mailing Address - Phone:270-737-7597
Mailing Address - Fax:270-769-5317
Practice Address - Street 1:701 N MULBERRY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1919
Practice Address - Country:US
Practice Address - Phone:270-769-5731
Practice Address - Fax:270-769-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty