Provider Demographics
NPI:1285668814
Name:ERICKSON, DONLYN JAY (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:DONLYN
Middle Name:JAY
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:ND
Mailing Address - Zip Code:58523-0326
Mailing Address - Country:US
Mailing Address - Phone:701-873-7677
Mailing Address - Fax:701-873-7718
Practice Address - Street 1:212 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:ND
Practice Address - Zip Code:58523-6970
Practice Address - Country:US
Practice Address - Phone:701-873-7677
Practice Address - Fax:701-873-7718
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND18346Medicaid
MT51V59EROtherMONTANA WORK COMP #
MN0029OtherMN LH&WF#
ND12947OtherBC/BS ND
ND350039040OtherRAILROAD MEDICARE
MT51V59EROtherBC/BS MONTANA
NDU54157Medicare UPIN
MT51V59EROtherBC/BS MONTANA