Provider Demographics
NPI:1679548838
Name:ERICKSON, NOAH C (DC)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:C
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 1:7000 SOUTH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3644
Mailing Address - Country:US
Mailing Address - Phone:330-726-3456
Mailing Address - Fax:330-726-2858
Practice Address - Street 1:7000 SOUTH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3644
Practice Address - Country:US
Practice Address - Phone:330-726-3456
Practice Address - Fax:330-726-2858
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009362111N00000X
OHDC 4332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V04771Medicare UPIN
V04771Medicare UPIN