Provider Demographics
NPI:1922169812
Name:BINGHAM, ERICK ROLAND (DC)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:ROLAND
Last Name:BINGHAM
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 1:155 S STATE ST STE B
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-2031
Mailing Address - Country:US
Mailing Address - Phone:801-922-4310
Mailing Address - Fax:801-922-4312
Practice Address - Street 1:155 S STATE ST STE B
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-2031
Practice Address - Country:US
Practice Address - Phone:801-922-4310
Practice Address - Fax:801-922-4312
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5159941-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU90984Medicare UPIN