Provider Demographics
NPI:1235150277
Name:EKIZIAN, ERIK GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:GREGORY
Last Name:EKIZIAN
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 1:790 LOUGHBOROUGH DRIVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348
Mailing Address - Country:US
Mailing Address - Phone:209-384-2100
Mailing Address - Fax:209-384-2177
Practice Address - Street 1:790 LOUGHBOROUGH DRIVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348
Practice Address - Country:US
Practice Address - Phone:209-384-2100
Practice Address - Fax:209-384-2177
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20963111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U39516Medicare UPIN
CADC0209630Medicare ID - Type Unspecified