Individual
DR. GRANT ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
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
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
2967
WI
111N00000X
Chiropractor
Primary
3100
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0238
HSM
—
01
—
231600
ACN
—
01
—
272GOER
BCBS - INDIVIDUAL
—
01
—
68541
ARAZ
—
Enumeration date
11/24/2006
Last updated
07/09/2007
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