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General NPI Number Information
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NPI Number | 1669610416
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Entity Type | Individual
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Provider Name | MATTHEW LEW ERICKSON D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/02/2009
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | 1013 3RD ST NE
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City | ROSEAU
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State | MN
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Zip | 56751-1209
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Country | US
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Telephone | 218-463-3880
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Fax | 218-463-2854
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Provider Business Mailing Address
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Address Line | 1013 3RD ST NE
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City | ROSEAU
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State | MN
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Zip | 56751-1209
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Country | US
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Telephone | 218-463-3880
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Fax | 218-463-2854
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5193
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License Number State | MN
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