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General NPI Number Information
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NPI Number | 1316673189
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Entity Type | Organization
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Legal Business Name | WAOMIRC GROUP LTD
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 521 S MILITARY AVE STE A
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City | GREEN BAY
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State | WI
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Zip | 54303-2209
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Country | US
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Telephone | 920-785-0398
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Fax |
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Provider Business Mailing Address
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Address Line | 521 S MILITARY AVE STE A
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City | GREEN BAY
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State | WI
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Zip | 54303-2209
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Country | US
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Telephone | 920-785-0398
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIC E VANDENHOUTEN
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Credential | P.HD,D.O.M.LAC
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Telephone | 920-785-0398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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