Provider Demographics
NPI:1215253828
Name:ERIKSEN CHIROPRACTIC OF RADCLIFF PLLC
Entity type:Organization
Organization Name:ERIKSEN CHIROPRACTIC OF RADCLIFF PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:ERIKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-737-7597
Mailing Address - Street 1:PO BOX 2588
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42702-2588
Mailing Address - Country:US
Mailing Address - Phone:270-737-7597
Mailing Address - Fax:270-769-5317
Practice Address - Street 1:125 W LINCOLN TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2055
Practice Address - Country:US
Practice Address - Phone:270-351-6074
Practice Address - Fax:270-351-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty