Jack Erickson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

7040 Issued in MN

Practice address

1565 Thomas Center Dr
Eagan, MN 55122-2642

Phone

(651) 734-6959

NPI assigned

Jan 3, 2023

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

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Life Clinic, P.a.Group PAC ID 5799934857, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Life Clinic, P.a.

  • Rehabilitation Chiropractor
  • St Louis Park, MN
  • NPI 1023296167
  Medicare reassignment Care Compare group NPD
• Lifeclinic PA

  • Rehabilitation Chiropractor
  • St Louis Park, MN
  • NPI 1922416064
  NPD (past)

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

{
    "created_epoch": "1672704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672704000000",
    "number": "1194438374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19153 ENCHANTED WAY",
            "city": "FARMINGTON",
            "state": "MN",
            "postal_code": "550248094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1565 THOMAS CENTER DR",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222642",
            "telephone_number": "651-734-6959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERICKSON",
        "first_name": "JACK",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-03",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "7040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Envision Center LLC
• Envisioning Wellness LLC
• Ashley Eppinger, NP
• Eloise Erasmus, PH.D
• Cassandra Donielle Erickson, PT
• Keith Robert Erickson, D.D.S.
• Michele Christine Erickson, M.D.
• Erickson/Aamodt Orthodontics PA
• Joshua Ericsson
• Sara Lynn Esboldt, LPN, CAB

• Chiropractor in Eagan, MN
• Providers in Eagan, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.