Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5053 | OR |
NPI | 1043579477 |
---|---|
Provider Name | Dr. Mark Erickson |
First Address | Portland, OR 97209 |
Second Address | Portland, OR 97209-2209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2012 |
Last Update Date | 04/05/2012 |