Provider Demographics
NPI:1295126787
Name:DR ERIC SPORTS AND REHAB
Entity type:Organization
Organization Name:DR ERIC SPORTS AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:FRIDTHJOV
Authorized Official - Last Name:NILSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-327-1325
Mailing Address - Street 1:516 E CARSON PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3214
Mailing Address - Country:US
Mailing Address - Phone:562-301-2742
Mailing Address - Fax:310-327-7058
Practice Address - Street 1:516 E CARSON PLAZA CT
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3214
Practice Address - Country:US
Practice Address - Phone:310-327-1325
Practice Address - Fax:310-327-7058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty