Provider Demographics
NPI:1538292438
Name:ERICKSON, BROCK T (DC)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:T
Last Name:ERICKSON
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 1:450 NE 20TH ST
Mailing Address - Street 2:#114
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431
Mailing Address - Country:US
Mailing Address - Phone:561-393-6231
Mailing Address - Fax:561-393-3831
Practice Address - Street 1:450 NE 20TH ST
Practice Address - Street 2:#114
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-393-6231
Practice Address - Fax:561-393-3831
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
55161Medicare ID - Type Unspecified
U50952Medicare UPIN