Provider Demographics
NPI:1922763374
Name:ERIKSEN, KYLE LEIF (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:LEIF
Last Name:ERIKSEN
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 1:4980 FLOWERS CHAPEL RD APT T140
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-5324
Mailing Address - Country:US
Mailing Address - Phone:334-648-4720
Mailing Address - Fax:
Practice Address - Street 1:3850 W MAIN ST STE 804
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1071
Practice Address - Country:US
Practice Address - Phone:334-699-6010
Practice Address - Fax:334-699-6012
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor