Provider Demographics
NPI:1194957571
Name:RECINE, ERIC (LAC CA)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:RECINE
Suffix:
Gender:M
Credentials:LAC CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7417 BUTTERFLY LN
Mailing Address - Street 2:
Mailing Address - City:SHIOCTON
Mailing Address - State:WI
Mailing Address - Zip Code:54170-8898
Mailing Address - Country:US
Mailing Address - Phone:920-915-9882
Mailing Address - Fax:
Practice Address - Street 1:1075 BROOKWOOD DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4135
Practice Address - Country:US
Practice Address - Phone:920-496-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI639055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist