Provider Demographics
NPI:1043727365
Name:KNUDSEN, ERIK THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:THOMAS
Last Name:KNUDSEN
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 1:2226 FINCH LN
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4489
Mailing Address - Country:US
Mailing Address - Phone:631-374-4241
Mailing Address - Fax:
Practice Address - Street 1:2226 FINCH LN
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4489
Practice Address - Country:US
Practice Address - Phone:631-374-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor