Provider Demographics
NPI:1982794129
Name:P & J HOLDINGS, INC
Entity Type:Organization
Organization Name:P & J HOLDINGS, INC
Other - Org Name:ERICKSON FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-758-4739
Mailing Address - Street 1:314 MAIN ST E
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-2448
Mailing Address - Country:US
Mailing Address - Phone:952-758-4739
Mailing Address - Fax:952-758-8047
Practice Address - Street 1:314 MAIN ST E
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-2448
Practice Address - Country:US
Practice Address - Phone:952-758-4739
Practice Address - Fax:952-758-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN135518000Medicaid
MN02B34RIOtherBLUE CROSS BLUE SHIELD OF MN
MN135518000Medicaid
MN350002338Medicare ID - Type Unspecified