Provider Demographics
NPI:1255881694
Name:ERICKSON CHIROPRACTIC HEALTH
Entity type:Organization
Organization Name:ERICKSON CHIROPRACTIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:T
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-393-6231
Mailing Address - Street 1:450 NE 20TH ST
Mailing Address - Street 2:#114
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-8160
Mailing Address - Country:US
Mailing Address - Phone:561-393-6231
Mailing Address - Fax:561-393-3831
Practice Address - Street 1:450 NE 20TH ST
Practice Address - Street 2:#114
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-8160
Practice Address - Country:US
Practice Address - Phone:561-393-6231
Practice Address - Fax:561-393-3831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLULZNGMedicare UPIN