Provider Demographics
NPI:1861640070
Name:WORDEN, ERICA JANE (DC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:JANE
Last Name:WORDEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17827 STATE HIGHWAY M
Mailing Address - Street 2:P.O. BOX 306
Mailing Address - City:IRONDALE
Mailing Address - State:MO
Mailing Address - Zip Code:63648-9552
Mailing Address - Country:US
Mailing Address - Phone:573-631-1821
Mailing Address - Fax:
Practice Address - Street 1:112 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:DESLOGE
Practice Address - State:MO
Practice Address - Zip Code:63601-3523
Practice Address - Country:US
Practice Address - Phone:573-631-1821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008017839111N00000X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor