Provider Demographics
NPI:1700982659
Name:HAUS, RYAN DAVID (DC DOCTOR OF CHIROPR)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DAVID
Last Name:HAUS
Suffix:
Gender:M
Credentials:DC DOCTOR OF CHIROPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 SOUTH PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935
Mailing Address - Country:US
Mailing Address - Phone:920-921-9100
Mailing Address - Fax:920-929-0464
Practice Address - Street 1:952 SOUTH PARK AVENUE
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935
Practice Address - Country:US
Practice Address - Phone:920-921-9100
Practice Address - Fax:920-929-0464
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI3392012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
35221Medicare ID - Type Unspecified
U66443Medicare UPIN