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Organization

BIRCH LAKE CHIROPRACTIC CLINIC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GRANT ERICKSON D.C. (OWNER)
(651) 429-5329
Entity
Organization

Contact information

Practice address
4635 WHITE BEAR PKWY, WHITE BEAR LAKE, MN 55110-3300
(651) 429-5329
(651) 429-2759
Mailing address
4635 WHITE BEAR PKWY, WHITE BEAR LAKE, MN 55110-3300
(651) 429-5329
(651) 429-2759

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
751
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
231600
ACN
01
273GOBI
BCBS - CLINIC #
01
6763511-00
MHCP
Enumeration date
11/24/2006
Last updated
03/17/2010
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