Provider Demographics
NPI:1881016517
Name:CARPENTER, ERIC JOHN (C AC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JOHN
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:C AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1786 SANCTUARY CT
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-7103
Mailing Address - Country:US
Mailing Address - Phone:708-310-0605
Mailing Address - Fax:960-968-8806
Practice Address - Street 1:2600 N RICHMOND ST
Practice Address - Street 2:SUITE C
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1956
Practice Address - Country:US
Practice Address - Phone:920-997-0511
Practice Address - Fax:920-968-8806
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI471-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist