MEDICARE: CHANTA L SLOMA DACM, LAC

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
1	171100000X	Acupuncturist	626-55	WI
2	171100000X	Acupuncturist	626-055	WI

General Provider Information

NPI Number	:	1962631127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTA L SLOMA DACM, LAC

Provider Business Mailing Address
First Line	:	1040 SUPERIOR ST
Second Line	:
City	:	STURGEON BAY
State	:	WI
Zip	:	54235-1841
Country	:	US
Telephone Number	:	920-493-0797
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 N 4TH AVE LOWR LEVEL
Second Line	:
City	:	STURGEON BAY
State	:	WI
Zip	:	54235-2405
Country	:	US
Telephone Number	:	920-493-0797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	11/21/2024

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