Provider Demographics
NPI:1174545933
Name:MCGOVERN, ERICKA ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:ERICKA
Middle Name:ELIZABETH
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7293 POST RD
Mailing Address - Street 2:
Mailing Address - City:N KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3212
Mailing Address - Country:US
Mailing Address - Phone:401-667-3773
Mailing Address - Fax:401-295-8607
Practice Address - Street 1:7293 POST RD
Practice Address - Street 2:
Practice Address - City:N KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3212
Practice Address - Country:US
Practice Address - Phone:401-667-3773
Practice Address - Fax:401-295-8607
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00470111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
410295OtherBLUE CHIP
4401321OtherUNC
007010702Medicare ID - Type Unspecified
U82626Medicare UPIN