Provider Demographics
NPI:1558731091
Name:FREDERIKSEN, ERIK (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:
Last Name:FREDERIKSEN
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:PO BOX 20860
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94620-0860
Mailing Address - Country:US
Mailing Address - Phone:510-566-5719
Mailing Address - Fax:
Practice Address - Street 1:5212 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1033
Practice Address - Country:US
Practice Address - Phone:510-566-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-27
Last Update Date:2015-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor