Healthcare Provider Details

I. General information

NPI: 1720244650
Provider Name (Legal Business Name): DALE G ERICKSON RD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 CENTER ST NE SUITE 2360
SALEM OR
97301-4532
US

IV. Provider business mailing address

3180 CENTER ST NE SUITE 2360
SALEM OR
97301-4532
US

V. Phone/Fax

Practice location:
  • Phone: 503-361-2606
  • Fax:
Mailing address:
  • Phone: 503-361-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: