Provider Demographics
NPI:1801939335
Name:ERIKSEN CHIROPRACTIC, PSC
Entity type:Organization
Organization Name:ERIKSEN CHIROPRACTIC, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:ERIKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-358-7070
Mailing Address - Street 1:631 TANNER RD
Mailing Address - Street 2:
Mailing Address - City:HODGENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42748-9642
Mailing Address - Country:US
Mailing Address - Phone:270-358-7070
Mailing Address - Fax:270-358-4617
Practice Address - Street 1:631 TANNER RD
Practice Address - Street 2:
Practice Address - City:HODGENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42748-9642
Practice Address - Country:US
Practice Address - Phone:270-358-7070
Practice Address - Fax:270-358-4617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTIN