Healthcare Provider Details

I. General information

NPI: 1730177569
Provider Name (Legal Business Name): SCOTT J ERICKSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COLLEGE PARK CT
SAVOY IL
61874-9660
US

IV. Provider business mailing address

2 COLLEGE PARK CT
SAVOY IL
61874-9660
US

V. Phone/Fax

Practice location:
  • Phone: 217-355-9577
  • Fax: 217-355-8842
Mailing address:
  • Phone: 217-355-9577
  • Fax: 217-355-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH4910
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: