Healthcare Provider Details

I. General information

NPI: 1669019709
Provider Name (Legal Business Name): TYLER JAMES ERICKSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PASEO CAMARILLO STE 160
CAMARILLO CA
93010-6085
US

IV. Provider business mailing address

11471 GLENSIDE LN
SANTA ROSA VALLEY CA
93012-9204
US

V. Phone/Fax

Practice location:
  • Phone: 805-987-1800
  • Fax:
Mailing address:
  • Phone: 805-405-2807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: