Provider Demographics
NPI:1760755904
Name:NILSEN, ERIC FRIDTHJOV (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:FRIDTHJOV
Last Name:NILSEN
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 1:5524 FERNHILL CIR
Mailing Address - Street 2:APT. B
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:516 E CARSON PLAZA CT
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3214
Practice Address - Country:US
Practice Address - Phone:310-327-1325
Practice Address - Fax:310-327-7058
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor