Provider Demographics
NPI:1710264700
Name:ERICKSON CHIROPRACTIC CLINIC INCORPORATED
Entity Type:Organization
Organization Name:ERICKSON CHIROPRACTIC CLINIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-781-7878
Mailing Address - Street 1:1162 CIRBY WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4479
Mailing Address - Country:US
Mailing Address - Phone:916-781-7878
Mailing Address - Fax:916-782-5965
Practice Address - Street 1:1162 CIRBY WAY STE 1
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4479
Practice Address - Country:US
Practice Address - Phone:916-781-7878
Practice Address - Fax:916-782-5965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 19684111NI0013X, 111NR0400X, 111NX0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty