Provider Demographics
NPI:1902038193
Name:ERICKSON, AMBER ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:ROSE
Last Name:ERICKSON
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 1:2998 BEECHWOOD INDUSTRIAL CT
Mailing Address - Street 2:
Mailing Address - City:HUBERTUS
Mailing Address - State:WI
Mailing Address - Zip Code:53033-9679
Mailing Address - Country:US
Mailing Address - Phone:262-628-8535
Mailing Address - Fax:262-628-8550
Practice Address - Street 1:2998 BEECHWOOD INDUSTRIAL CT
Practice Address - Street 2:
Practice Address - City:HUBERTUS
Practice Address - State:WI
Practice Address - Zip Code:53033-9679
Practice Address - Country:US
Practice Address - Phone:262-628-8535
Practice Address - Fax:262-628-8550
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4531-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor