Provider Demographics
NPI:1245381722
Name:MARTIN ERLANDSON DCSC
Entity Type:Organization
Organization Name:MARTIN ERLANDSON DCSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:LINDAHL
Authorized Official - Last Name:ERLANDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-634-3193
Mailing Address - Street 1:700 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBY
Mailing Address - State:WI
Mailing Address - Zip Code:54667-1335
Mailing Address - Country:US
Mailing Address - Phone:608-634-3193
Mailing Address - Fax:608-634-2193
Practice Address - Street 1:700 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBY
Practice Address - State:WI
Practice Address - Zip Code:54667-1335
Practice Address - Country:US
Practice Address - Phone:608-634-3193
Practice Address - Fax:608-634-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1643 - 012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI75-561Medicare ID - Type Unspecified
WIT61874Medicare UPIN
WI38769100Medicare ID - Type Unspecified