Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 83-169476-1202 | UT |
NPI | 1801832241 |
---|---|
Provider Name | Neil Louis Erickson |
First Address | Providence, UT 84332-9856 |
Second Address | Providence, UT 84332-9856 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 20/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T78064 | (02) | UT |