Provider Demographics
NPI:1417098609
Name:TKACSIK, ERIC (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:TKACSIK
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 1:1215 OLD FAIRHAVEN PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7444
Mailing Address - Country:US
Mailing Address - Phone:360-714-0693
Mailing Address - Fax:360-714-6124
Practice Address - Street 1:1215 OLD FAIRHAVEN PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7444
Practice Address - Country:US
Practice Address - Phone:360-714-0693
Practice Address - Fax:360-714-6124
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU85389Medicare UPIN
WAAB32206Medicare ID - Type Unspecified