Provider Demographics
NPI:1184193807
Name:GAITAN, ERICK RICARDO (DC)
Entity Type:Individual
Prefix:DR
First Name:ERICK
Middle Name:RICARDO
Last Name:GAITAN
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 1:6452 LAKE MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3927
Mailing Address - Country:US
Mailing Address - Phone:703-927-7002
Mailing Address - Fax:
Practice Address - Street 1:4123 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1155
Practice Address - Country:US
Practice Address - Phone:202-265-6000
Practice Address - Fax:202-265-6018
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557532111N00000X
DCCH030194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor