Provider Demographics
NPI:1023292661
Name:ERICKSON, EDMUND (L AC)
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24432 MUIRLANDS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3939
Mailing Address - Country:US
Mailing Address - Phone:949-770-2249
Mailing Address - Fax:949-340-0159
Practice Address - Street 1:24432 MUIRLANDS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3939
Practice Address - Country:US
Practice Address - Phone:949-770-2249
Practice Address - Fax:949-340-0159
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9371171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist