Provider Demographics
NPI:1447581202
Name:ERICKSON CHIROPRACTIC PC
Entity Type:Organization
Organization Name:ERICKSON CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONLYN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-873-7677
Mailing Address - Street 1:212 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:ND
Mailing Address - Zip Code:58523-6970
Mailing Address - Country:US
Mailing Address - Phone:701-873-7677
Mailing Address - Fax:701-873-7718
Practice Address - Street 1:212 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:ND
Practice Address - Zip Code:58523-6970
Practice Address - Country:US
Practice Address - Phone:701-873-7677
Practice Address - Fax:701-873-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0029OtherMN LH&WF
ND12947OtherBLUE CROSS/BLUE SHIELD OF NORTH DAKOTA
ND18346Medicaid
ND18346Medicaid
NDU54157Medicare UPIN