Healthcare Provider Details

I. General information

NPI: 1265676803
Provider Name (Legal Business Name): JODY LEIGH ERICKSON D.O.M., D.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1472 1/2 S SAINT FRANCIS DR
SANTA FE NM
87505-4038
US

IV. Provider business mailing address

PO BOX 2468
SANTA FE NM
87504-2468
US

V. Phone/Fax

Practice location:
  • Phone: 505-474-4550
  • Fax:
Mailing address:
  • Phone: 505-474-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number146
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: