Provider Demographics
NPI:1891236105
Name:ERLANDSON, MCKENZIE RAE (DC)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:RAE
Last Name:ERLANDSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:RAE
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2507 FOX RUN PKWY
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-5318
Mailing Address - Country:US
Mailing Address - Phone:605-665-8073
Mailing Address - Fax:605-668-9653
Practice Address - Street 1:2507 FOX RUN PKWY
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-5318
Practice Address - Country:US
Practice Address - Phone:605-665-8073
Practice Address - Fax:605-668-9653
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor