Provider Demographics
NPI:1851619654
Name:LANDER, ERIC MARTIN (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:MARTIN
Last Name:LANDER
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 1:679 BIDWELL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-3637
Mailing Address - Country:US
Mailing Address - Phone:864-593-4879
Mailing Address - Fax:
Practice Address - Street 1:1025 SELBY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6533
Practice Address - Country:US
Practice Address - Phone:864-593-4879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor