Provider Demographics
NPI:1346622032
Name:ERICKSON CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:ERICKSON CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, DC, BS, DACBN
Authorized Official - Phone:716-665-6226
Mailing Address - Street 1:428 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-2757
Mailing Address - Country:US
Mailing Address - Phone:716-665-6226
Mailing Address - Fax:716-665-3159
Practice Address - Street 1:428 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-2757
Practice Address - Country:US
Practice Address - Phone:716-665-6226
Practice Address - Fax:716-665-3159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56926BOtherMEDICARE ID