Provider Demographics
NPI:1952533598
Name:ERICKSON, AUSTIN W (DC, BA, BS)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:W
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:DC, BA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 WESTGATE RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-4963
Mailing Address - Country:US
Mailing Address - Phone:715-552-7889
Mailing Address - Fax:
Practice Address - Street 1:1740 WESTGATE RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-4963
Practice Address - Country:US
Practice Address - Phone:715-552-7889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-16
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4506-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor