Provider Demographics
NPI:1609927664
Name:HOUK, ROBERTA JO (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:JO
Last Name:HOUK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 APPLETON RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1101
Mailing Address - Country:US
Mailing Address - Phone:192-072-2545
Mailing Address - Fax:
Practice Address - Street 1:1403 APPLETON RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1101
Practice Address - Country:US
Practice Address - Phone:192-072-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1522111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor