Provider Demographics
NPI:1184947608
Name:ERICKSON, STEPHANIE D (DC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
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 1:6615 W HAPPYVALLEY RD
Mailing Address - Street 2:STE B105
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310
Mailing Address - Country:US
Mailing Address - Phone:623-572-9820
Mailing Address - Fax:623-572-9830
Practice Address - Street 1:6615 W HAPPY VALLEY RD
Practice Address - Street 2:STE B105
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-2608
Practice Address - Country:US
Practice Address - Phone:623-572-9820
Practice Address - Fax:623-572-9830
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor