Provider Demographics
NPI:1134176449
Name:ERICKSON, LINN WESLEY (DC)
Entity type:Individual
Prefix:DR
First Name:LINN
Middle Name:WESLEY
Last Name:ERICKSON
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 1:5733 S 34TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6633
Mailing Address - Country:US
Mailing Address - Phone:402-483-0804
Mailing Address - Fax:402-323-8834
Practice Address - Street 1:5733 S 34TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6633
Practice Address - Country:US
Practice Address - Phone:402-483-0804
Practice Address - Fax:402-323-8834
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470837892-00Medicaid
NE274144Medicare ID - Type Unspecified
NE470837892-00Medicaid