Healthcare Provider Details

I. General information

NPI: 1710264700
Provider Name (Legal Business Name): ERICKSON CHIROPRACTIC CLINIC INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1162 CIRBY WAY STE 1
ROSEVILLE CA
95661-4479
US

IV. Provider business mailing address

1162 CIRBY WAY STE 1
ROSEVILLE CA
95661-4479
US

V. Phone/Fax

Practice location:
  • Phone: 916-781-7878
  • Fax: 916-782-5965
Mailing address:
  • Phone: 916-781-7878
  • Fax: 916-782-5965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC 19684
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC 19684
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License NumberDC 19684
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC 19684
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD ANTHONY FINK
Title or Position: CEO
Credential: DC
Phone: 916-781-7878