Provider Demographics
NPI:1215037692
Name:CLAUSEN, ERIC RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:RICHARD
Last Name:CLAUSEN
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 1:223 N. PINE ST
Mailing Address - Street 2:PO BOX 187
Mailing Address - City:HORTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54944-9140
Mailing Address - Country:US
Mailing Address - Phone:920-779-3300
Mailing Address - Fax:920-779-3301
Practice Address - Street 1:223 NORTH PINE ST
Practice Address - Street 2:PO BOX 187
Practice Address - City:HORTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54944
Practice Address - Country:US
Practice Address - Phone:920-779-3300
Practice Address - Fax:920-779-3301
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3935-12111N00000X
WI3935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38964700Medicaid
U98302Medicare UPIN
000475055Medicare ID - Type Unspecified