Provider Demographics
NPI:1427154087
Name:ERICKSON, KENYON LANCE (DC)
Entity type:Individual
Prefix:DR
First Name:KENYON
Middle Name:LANCE
Last Name:ERICKSON
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 1:1211 PIERRE ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-4331
Mailing Address - Country:US
Mailing Address - Phone:785-587-8720
Mailing Address - Fax:
Practice Address - Street 1:1213 HYLTON HEIGHTS RD
Practice Address - Street 2:SUITE 117
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2810
Practice Address - Country:US
Practice Address - Phone:785-539-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060835Medicare ID - Type UnspecifiedMEDICARE & BLUE CROSS #