Provider Demographics
NPI:1093727968
Name:STARBUCK, ERIC ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ALAN
Last Name:STARBUCK
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 1:2485 MAPLEWOOD DR.
Mailing Address - Street 2:STE 215
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109
Mailing Address - Country:US
Mailing Address - Phone:651-770-7938
Mailing Address - Fax:651-765-0995
Practice Address - Street 1:2485 MAPLEWOOD DR
Practice Address - Street 2:STE 215
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109
Practice Address - Country:US
Practice Address - Phone:651-770-7938
Practice Address - Fax:651-765-0995
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN564440000Medicaid
MN564440000Medicaid