Provider Demographics
NPI:1669019709
Name:ERICKSON, TYLER JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JAMES
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 1:11471 GLENSIDE LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93012-9204
Mailing Address - Country:US
Mailing Address - Phone:805-405-2807
Mailing Address - Fax:
Practice Address - Street 1:1200 PASEO CAMARILLO STE 160
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6085
Practice Address - Country:US
Practice Address - Phone:805-987-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty