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NPI Code Detail

MEDICARE: DR. ERIK WILLEM WAARDENBURG DC

MEDICARE: DR. ERIK WILLEM WAARDENBURG DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor2301008749MI

General Provider Information

NPI Number : 1689629040
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIK WILLEM WAARDENBURG DC
Provider Business Mailing Address
First Line : 45259 SYCAMORE CT
Second Line :
City : SHELBY TOWNSHIP
State : MI
Zip : 48317-4935
Country : US
Telephone Number : 989-274-6512
Fax Number :
Provider Business Practice Location Address
First Line : 57911 VAN DYKE RD
Second Line :
City : WASHINGTON
State : MI
Zip : 48094-2763
Country : US
Telephone Number : 586-781-0800
Fax Number : 586-781-2426
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 07/08/2007

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Directions to “ DR. ERIK WILLEM WAARDENBURG DC” Practice Location

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