Provider Demographics
NPI:1962631127
Name:VANLAANEN, CHANTA L (LAC)
Entity Type:Individual
Prefix:
First Name:CHANTA
Middle Name:L
Last Name:VANLAANEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 221
Mailing Address - Street 2:
Mailing Address - City:FISH CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:54212-0221
Mailing Address - Country:US
Mailing Address - Phone:920-256-1660
Mailing Address - Fax:
Practice Address - Street 1:7775 STATE HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:EGG HARBOR
Practice Address - State:WI
Practice Address - Zip Code:54209
Practice Address - Country:US
Practice Address - Phone:920-256-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI626-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist