Provider Demographics
NPI:1417613563
Name:ERICKSON, DUSTIN W
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:W
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14040 COUNTY ROAD 47
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807-9443
Mailing Address - Country:US
Mailing Address - Phone:719-342-5380
Mailing Address - Fax:
Practice Address - Street 1:14040 COUNTY ROAD 47
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-9443
Practice Address - Country:US
Practice Address - Phone:719-342-5380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
No171W00000XOther Service ProvidersContractor