Organization
CHIROPRACTIC SPORT & SPINAL REHAB PA
Active
Other names
Northern Chiropractic Pain Relief & Injury Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYLE RICHARD ERICKSON D.C. (OWNER/CHIROPRACTOR)
(218) 386-1930
Entity
Organization
Contact information
Practice address
201 LAKE ST NW, SUITE G, WARROAD, MN 56763-2116
(218) 386-1930
(218) 386-1921
Mailing address
201 LAKE ST NW, SUITE G, PO BOX 930, WARROAD, MN 56763-2116
(218) 386-1930
(218) 386-1921
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3705
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
420M4CH
BCBS OF MN
MN
05
—
485263000
—
MN
Enumeration date
06/11/2006
Last updated
03/26/2013
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