Mark Erickson, D.C., M.SC

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

5053 Issued in OR

Practice address

625 NW 17TH Ave
Portland, OR 97209-2209

Phone

(503) 924-6535

NPI assigned

May 4, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kinetic Integration Sports Injuries & Rehabilitation, LLC

  • Sports Physician Chiropractor
  • Beaverton, OR
  • NPI 1568728517
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336089600000",
    "number": "1043579477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 NW 17TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 NW 17TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972092209",
            "telephone_number": "503-924-6535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERICKSON",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "D.C., M.SC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-04",
        "last_updated": "2012-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "OR",
            "license": "5053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jane Lee Erickson, LPC
• Jasper Erickson, MD
• Katherine M Erickson, MD
• Kim K Erickson, DMD, MD
• Kristin A Erickson
• Molly Janezich Erickson, LAC
• Neil Erickson
• Shelby Rae Erickson
• Spencer Emil Erickson, RN, NP
• Victoria Miller Erickson, MD

• Sports Physician Chiropractor in Portland, OR
• Providers in Portland, OR by specialty
• Sports Physician Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.