Provider Demographics
NPI:1558309203
Name:LIAZUK, ERIC JAMES (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:LIAZUK
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 1:1840 POST RD
Mailing Address - Street 2:STE 6
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-2832
Mailing Address - Country:US
Mailing Address - Phone:715-342-4027
Mailing Address - Fax:715-342-4430
Practice Address - Street 1:1840 POST RD
Practice Address - Street 2:# 6
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-2832
Practice Address - Country:US
Practice Address - Phone:715-342-4027
Practice Address - Fax:715-342-4430
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4181-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38994000OtherMEDICAID GROUP
115599OtherSECURITY HEALTH PLAN
WI38965500Medicaid
WIV08406Medicare UPIN
WI38994000OtherMEDICAID GROUP