Provider Demographics
NPI:1164743076
Name:ERICKSON, DANIEL (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ERICKSON
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 1:1873 WYNCOOP CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHEMUNG
Mailing Address - State:NY
Mailing Address - Zip Code:14825-9720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1873 WYNCOOP CREEK RD
Practice Address - Street 2:
Practice Address - City:CHEMUNG
Practice Address - State:NY
Practice Address - Zip Code:14825-9720
Practice Address - Country:US
Practice Address - Phone:607-846-8249
Practice Address - Fax:607-846-8249
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor