Provider Demographics
NPI:1730177569
Name:ERICKSON, SCOTT J (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:J
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 1:2 COLLEGE PARK CT
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-9660
Mailing Address - Country:US
Mailing Address - Phone:217-355-9577
Mailing Address - Fax:217-355-8842
Practice Address - Street 1:2 COLLEGE PARK CT
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9660
Practice Address - Country:US
Practice Address - Phone:217-355-9577
Practice Address - Fax:217-355-8842
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4910111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01082019OtherBLUE CROSS BLUE SHIELD
IL01082019OtherBLUE CROSS BLUE SHIELD
IL200243Medicare ID - Type Unspecified