Provider Demographics
NPI:1174678221
Name:ERICKSON, JAMES CLAYTON (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLAYTON
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 1:1203 OLD TROLLEY RD STE F
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5296
Mailing Address - Country:US
Mailing Address - Phone:843-486-0999
Mailing Address - Fax:843-486-0989
Practice Address - Street 1:1203 OLD TROLLEY RD STE F
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5296
Practice Address - Country:US
Practice Address - Phone:843-486-0999
Practice Address - Fax:843-486-0989
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010503111N00000X
SC3745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213039Medicare ID - Type Unspecified
ILY42064Medicare UPIN