Provider Demographics
NPI:1871642926
Name:KNUDSON, ERIC A (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:A
Last Name:KNUDSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 CAPITOL ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-6002
Mailing Address - Country:US
Mailing Address - Phone:707-642-6266
Mailing Address - Fax:
Practice Address - Street 1:521 CAPITOL ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-6002
Practice Address - Country:US
Practice Address - Phone:707-642-6266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 14960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor