Provider Demographics
NPI:1811425424
Name:ERICKSON, ERIC M (LAC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:M
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 PECK RD. #F
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732
Mailing Address - Country:US
Mailing Address - Phone:626-747-5077
Mailing Address - Fax:626-773-8996
Practice Address - Street 1:9105 E. VALLEY BLVD. SUITE 101
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770
Practice Address - Country:US
Practice Address - Phone:626-747-5077
Practice Address - Fax:626-773-8996
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17485171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty