Provider Demographics
NPI:1487075800
Name:DIERKSEN, ERIC DEAN (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DEAN
Last Name:DIERKSEN
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 1:324C SOUTHWIND PL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-3134
Mailing Address - Country:US
Mailing Address - Phone:785-320-5300
Mailing Address - Fax:
Practice Address - Street 1:324C SOUTHWIND PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-3134
Practice Address - Country:US
Practice Address - Phone:785-320-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor