Erickson Chiropractic PC – Chiropractor in Beulah, ND

Key facts

NPI: 1447581202
Entity type: Organization (NPI type 2)
Primary specialty: Chiropractor 111N00000X
License: 583 (ND)
Legal business name: ERICKSON CHIROPRACTIC PC
Practice address: 212 W Main St
Beulah, ND 58523-6970
Phone: (701) 873-7677
Fax: (701) 873-7718
NPI assigned: Jan 19, 2010
Organization subpart: No

Authorized official

Name: Dr. Donlyn Jay Erickson, D.C. NPI 1285668814
Title: Chiropractor
Phone: (701) 873-7677

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Donlyn Jay Erickson, D.C., C.C.S.P. Chiropractor · Beulah, ND · NPI 1285668814

Medicare reassignment Care Compare group NPD Authorized official CHIROPRACTOR · ND
Travis Jason Voegele, D.C. Chiropractor · Beulah, ND · NPI 1245580703

Medicare reassignment Care Compare group NPD CHIROPRACTOR · ND

Medicare participation

Medicare fee-for-service enrollment: Enrolled in ND

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20100525000386	ND	Part B Supplier - Clinic/Group Practice	4981733250	Receives reassigned benefits from 2 practitioners Practice locations: Beulah, ND

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Chiropractor Group: 193400000X SINGLE SPECIALTY GROUP	111N00000X	583	ND	Yes

Addresses

Primary practice location

212 W Main St
Beulah, ND 58523-6970

Mailing address

212 W Main St
Beulah, ND 58523-6970
Phone (701) 873-7677

Other identifiers

Identifier	Type	State	Issuer
0029	Other	MN	MN LH&WF
12947	Other	ND	BLUE CROSS/BLUE SHIELD OF NORTH DAKOTA
18346	Medicaid	ND

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 13, 2010.

{
    "created_epoch": "1263859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273708800000",
    "number": "1447581202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 W MAIN ST",
            "city": "BEULAH",
            "state": "ND",
            "postal_code": "585236970",
            "telephone_number": "701-873-7677",
            "fax_number": "701-873-7718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 W MAIN ST",
            "city": "BEULAH",
            "state": "ND",
            "postal_code": "585236970",
            "telephone_number": "701-873-7677",
            "fax_number": "701-873-7718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERICKSON CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-19",
        "last_updated": "2010-05-13",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "DONLYN",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "701-873-7677",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "ND",
            "license": "583",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN LH&WF",
            "identifier": "0029",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD OF NORTH DAKOTA",
            "identifier": "12947",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18346",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beulah, ND

All providers in Beulah, ND · Chiropractor in North Dakota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.