MEDICARE: ERICKSON CHIROPRACTIC CLINIC, P.C.

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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1568729952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERICKSON CHIROPRACTIC CLINIC, P.C.

Provider Business Mailing Address
First Line	:	8996 W UNION HILLS DR
Second Line	:	SUITE 103
City	:	PEORIA
State	:	AZ
Zip	:	85382-3010
Country	:	US
Telephone Number	:	623-566-4694
Fax Number	:	623-566-6025

Provider Business Practice Location Address
First Line	:	8996 W UNION HILLS DR
Second Line	:	SUITE 103
City	:	PEORIA
State	:	AZ
Zip	:	85382-3010
Country	:	US
Telephone Number	:	623-566-4694
Fax Number	:	623-566-6025

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. STEVEN JAMES ERICKSON
Credential	:	D.C.
Telephone Number	:	623-566-4694

Provider Enumeration Date	:	04/23/2012
Last Update Date	:	04/23/2012

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