Provider Demographics
NPI:1649370792
Name:ERIKSEN, WILLIAM C (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:ERIKSEN
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 1:415 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2769
Mailing Address - Country:US
Mailing Address - Phone:270-737-7597
Mailing Address - Fax:
Practice Address - Street 1:701 N MULBERRY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1919
Practice Address - Country:US
Practice Address - Phone:270-769-5731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001733Medicaid
KYU85311Medicare UPIN
KY6094501Medicare ID - Type Unspecified