Healthcare Provider Details

I. General information

NPI: 1245381722
Provider Name (Legal Business Name): MARTIN ERLANDSON DCSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S MAIN ST
WESTBY WI
54667-1335
US

IV. Provider business mailing address

700 S MAIN ST
WESTBY WI
54667-1335
US

V. Phone/Fax

Practice location:
  • Phone: 608-634-3193
  • Fax: 608-634-2193
Mailing address:
  • Phone: 608-634-3193
  • Fax: 608-634-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1643 - 012
License Number StateWI

VIII. Authorized Official

Name: DR. MARTIN LINDAHL ERLANDSON
Title or Position: PRESIDENT
Credential: DC
Phone: 608-634-3193