Provider Demographics
NPI:1508690298
Name:SODERBERG, ERIC (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:SODERBERG
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 1:32809 COUNTY ROAD 326
Mailing Address - Street 2:
Mailing Address - City:BOVEY
Mailing Address - State:MN
Mailing Address - Zip Code:55709-5573
Mailing Address - Country:US
Mailing Address - Phone:218-259-9254
Mailing Address - Fax:
Practice Address - Street 1:104 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2869
Practice Address - Country:US
Practice Address - Phone:218-301-7226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor