Provider Demographics
NPI:1801483193
Name:MADSEN, ERIK (DC)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:
Last Name:MADSEN
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 1:1471 E TAMERON DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-3673
Mailing Address - Country:US
Mailing Address - Phone:801-971-2774
Mailing Address - Fax:
Practice Address - Street 1:1425 S STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7703
Practice Address - Country:US
Practice Address - Phone:801-226-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12073146-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor