Provider Demographics
NPI:1508208927
Name:ERICKSON, DARLA A (DIPL AC)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:A
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9377 WENTLOCK RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3419
Mailing Address - Country:US
Mailing Address - Phone:651-491-5272
Mailing Address - Fax:
Practice Address - Street 1:670 COMMERCE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9206
Practice Address - Country:US
Practice Address - Phone:651-491-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1821430661OtherNPI TYPE 2 ORGANIZATION NUMBER