Provider Demographics
NPI:1609524354
Name:VANDENHOUTEN, ERIC EUGENE (PHD, DOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:EUGENE
Last Name:VANDENHOUTEN
Suffix:
Gender:M
Credentials:PHD, DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 RIVERVIEW DR APT 4
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-6514
Mailing Address - Country:US
Mailing Address - Phone:920-785-0398
Mailing Address - Fax:
Practice Address - Street 1:521 S MILITARY AVE STE A
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-2209
Practice Address - Country:US
Practice Address - Phone:920-785-0398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI908-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist