Healthcare Provider Details

I. General information

NPI: 1285668814
Provider Name (Legal Business Name): DONLYN JAY ERICKSON D.C., C.C.S.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W MAIN ST
BEULAH ND
58523-6970
US

IV. Provider business mailing address

PO BOX 326
BEULAH ND
58523-0326
US

V. Phone/Fax

Practice location:
  • Phone: 701-873-7677
  • Fax: 701-873-7718
Mailing address:
  • Phone: 701-873-7677
  • Fax: 701-873-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number583
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: