Provider Demographics
NPI:1366975484
Name:AYEN, ERIC A (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:A
Last Name:AYEN
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 1:1050 MAPLEBECK PL NE
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:MN
Mailing Address - Zip Code:55920-1584
Mailing Address - Country:US
Mailing Address - Phone:507-358-9729
Mailing Address - Fax:
Practice Address - Street 1:1067 4TH ST NE
Practice Address - Street 2:SUITE 200
Practice Address - City:BYRON
Practice Address - State:MN
Practice Address - Zip Code:55920-5002
Practice Address - Country:US
Practice Address - Phone:507-358-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor