Provider Demographics
NPI:1457454233
Name:MCKILLICAN, ERIC JON (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JON
Last Name:MCKILLICAN
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32605 TEMECULA PKWY STE 204
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6839
Mailing Address - Country:US
Mailing Address - Phone:951-303-6696
Mailing Address - Fax:951-383-8013
Practice Address - Street 1:32605 TEMECULA PKWY STE 204
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6839
Practice Address - Country:US
Practice Address - Phone:951-303-6696
Practice Address - Fax:951-383-8013
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0233200OtherBLUE SHIELD
CAU59361Medicare UPIN