Provider Demographics
NPI:1174563928
Name:ERICKSON, BRIAN S (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7486 MARTINSBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443
Mailing Address - Country:US
Mailing Address - Phone:304-876-8200
Mailing Address - Fax:304-876-6826
Practice Address - Street 1:7486 MARTINSBURG PIKE
Practice Address - Street 2:
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443
Practice Address - Country:US
Practice Address - Phone:304-876-8200
Practice Address - Fax:304-876-6826
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0132165000Medicaid
0815453Medicare PIN
WVU64278Medicare UPIN