Organization
CACHE VALLEY CHIROPRACTIC CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NEIL LOUIS ERICKSON DC (OWNER)
(435) 752-2772
Entity
Organization
Contact information
Practice address
169 N GATEWAY DR STE 223, PROVIDENCE, UT 84332-9856
(435) 752-2772
(435) 752-2878
Mailing address
169 N GATEWAY DR STE 223, PROVIDENCE, UT 84332-9856
(435) 752-7722
(435) 752-2878
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
169476-1202
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10294
ALTIUS
UT
01
—
22321
PEHP
UT
05
—
519720002009
—
UT
01
—
870395551ER1
EMIA
UT
01
—
94287113577001
BLUE CROSS BLUE SHIELD
UT
Enumeration date
01/31/2007
Last updated
05/20/2020
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