Provider Demographics
NPI:1831341478
Name:ERICKSON, LORENZO CARL (DC)
Entity type:Individual
Prefix:
First Name:LORENZO
Middle Name:CARL
Last Name:ERICKSON
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 1:5210 MILL POND DR SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-3825
Mailing Address - Country:US
Mailing Address - Phone:972-358-9028
Mailing Address - Fax:
Practice Address - Street 1:4329 A ST SE UNIT F
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-8618
Practice Address - Country:US
Practice Address - Phone:253-929-6413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60947380111N00000X
LA1627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty