Provider Demographics
NPI:1336279546
Name:PUTNAM, ERIKA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:LYNN
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W. IOWA AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-2856
Mailing Address - Country:US
Mailing Address - Phone:208-442-1123
Mailing Address - Fax:
Practice Address - Street 1:430 W. IOWA AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-2856
Practice Address - Country:US
Practice Address - Phone:208-442-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-844111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDCHIA-844OtherSTATE LICENSE NUMBER
ID1673739Medicare ID - Type Unspecified
IDU64605Medicare UPIN