Provider Demographics
NPI:1184902918
Name:BASSO, ERICA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LYNN
Last Name:BASSO
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 1:124 CHICKASAW RUN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-1703
Mailing Address - Country:US
Mailing Address - Phone:770-990-2121
Mailing Address - Fax:
Practice Address - Street 1:1125 WOODSTOCK RD
Practice Address - Street 2:SUITE 340
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-8220
Practice Address - Country:US
Practice Address - Phone:770-990-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008844111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor