Provider Demographics
NPI:1689629040
Name:WAARDENBURG, ERIK WILLEM (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:WILLEM
Last Name:WAARDENBURG
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 1:45259 SYCAMORE CT
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-4935
Mailing Address - Country:US
Mailing Address - Phone:989-274-6512
Mailing Address - Fax:
Practice Address - Street 1:57911 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-2763
Practice Address - Country:US
Practice Address - Phone:586-781-0800
Practice Address - Fax:586-781-2426
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N26050Medicare ID - Type Unspecified
MIU97784Medicare UPIN