Provider Demographics
NPI:1386774040
Name:ERICKSON & ERICKSON LLC
Entity type:Organization
Organization Name:ERICKSON & ERICKSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-760-1333
Mailing Address - Street 1:1704 SOUTH HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3326
Mailing Address - Country:US
Mailing Address - Phone:336-760-1333
Mailing Address - Fax:336-760-9111
Practice Address - Street 1:1704 SOUTH HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3326
Practice Address - Country:US
Practice Address - Phone:336-760-1333
Practice Address - Fax:336-760-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1023Medicare PIN