Provider Demographics
NPI:1215311329
Name:MACIAS, ERICK KEITH (DC)
Entity type:Individual
Prefix:DR
First Name:ERICK
Middle Name:KEITH
Last Name:MACIAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 AVALON DR UNIT 6302
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-1043
Mailing Address - Country:US
Mailing Address - Phone:201-390-5255
Mailing Address - Fax:
Practice Address - Street 1:3800 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4851
Practice Address - Country:US
Practice Address - Phone:201-319-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00709500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor