MEDICARE: DR ERIC SPORTS AND REHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1295126787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR ERIC SPORTS AND REHAB

Provider Business Mailing Address
First Line	:	516 E CARSON PLAZA CT
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90746-3214
Country	:	US
Telephone Number	:	562-301-2742
Fax Number	:	310-327-7058

Provider Business Practice Location Address
First Line	:	516 E CARSON PLAZA CT
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90746-3214
Country	:	US
Telephone Number	:	310-327-1325
Fax Number	:	310-327-7058

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	ERIC FRIDTHJOV NILSEN
Credential	:	DC
Telephone Number	:	310-327-1325

Provider Enumeration Date	:	02/05/2015
Last Update Date	:	09/15/2023

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Directions to “DR ERIC SPORTS AND REHAB ” Practice Location

Language	Start Address	Practice Location

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