Healthcare Provider Details

I. General information

NPI: 1487024295
Provider Name (Legal Business Name): ERIK EUGENE MICHENER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 CENTRAL PKWY N STE 300
SAN ANTONIO TX
78232-5053
US

IV. Provider business mailing address

911 CENTRAL PKWY N STE 300
SAN ANTONIO TX
78232-5053
US

V. Phone/Fax

Practice location:
  • Phone: 210-249-4874
  • Fax:
Mailing address:
  • Phone: 210-249-4874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4480
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2014039521
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: