Healthcare Provider Details

I. General information

NPI: 1861640070
Provider Name (Legal Business Name): ERICA JANE WORDEN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N LINCOLN ST
DESLOGE MO
63601-3523
US

IV. Provider business mailing address

17827 STATE HIGHWAY M P.O. BOX 306
IRONDALE MO
63648-9552
US

V. Phone/Fax

Practice location:
  • Phone: 573-631-1821
  • Fax:
Mailing address:
  • Phone: 573-631-1821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2008017839
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number2008017839
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: