Provider Demographics
NPI:1689998429
Name:ERICHSEN FAMILY CHIROPRACTIC & WELLNESS CENTER PA
Entity Type:Organization
Organization Name:ERICHSEN FAMILY CHIROPRACTIC & WELLNESS CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICHSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-226-3390
Mailing Address - Street 1:175 FAIRFIELD AVE
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6425
Mailing Address - Country:US
Mailing Address - Phone:973-226-3390
Mailing Address - Fax:973-226-3397
Practice Address - Street 1:175 FAIRFIELD AVE
Practice Address - Street 2:SUITE 5A
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6425
Practice Address - Country:US
Practice Address - Phone:973-226-3390
Practice Address - Fax:973-226-3397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00560500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ045618Medicare UPIN