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General NPI Number Information
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NPI Number | 1891788675
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Entity Type | Individual
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Provider Name | TIMOTHY JAMES ERICKSON DC
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Gender | Male
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 3108 S ROUTE 59 STE 124
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City | NAPERVILLE
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State | IL
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Zip | 60564-7804
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Country | US
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Telephone | 630-983-1805
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Fax | 630-983-1845
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Provider Business Mailing Address
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Address Line | 24115 103RD ST SUITE A
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City | NAPERVILLE
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State | IL
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Zip | 60564-8012
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Country | US
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Telephone | 630-983-1805
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Fax |
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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 | 038010212
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License Number State | IL
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