Provider Demographics
NPI:1437654423
Name:ERICKSON, BRENNA (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENNA
Middle Name:
Last Name:ERICKSON
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 1:3208 HENNEPIN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3447
Mailing Address - Country:US
Mailing Address - Phone:612-367-7216
Mailing Address - Fax:
Practice Address - Street 1:3208 HENNEPIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3447
Practice Address - Country:US
Practice Address - Phone:612-367-7216
Practice Address - Fax:844-373-1939
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6644111N00000X
CA34177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor