Healthcare Provider Details

I. General information

NPI: 1447581202
Provider Name (Legal Business Name): ERICKSON CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 05/13/2010
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

212 W MAIN ST
BEULAH ND
58523-6970
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: DR. DONLYN JAY ERICKSON
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 701-873-7677