Provider Demographics
NPI:1699091413
Name:TANCZOS, ERIKA MARIA
Entity type:Individual
Prefix:MISS
First Name:ERIKA
Middle Name:MARIA
Last Name:TANCZOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7351 PINNACLE PINES DR APT B8
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3713
Mailing Address - Country:US
Mailing Address - Phone:239-265-4597
Mailing Address - Fax:
Practice Address - Street 1:8595 COLLEGE PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5191
Practice Address - Country:US
Practice Address - Phone:239-489-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA58919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor