Provider Demographics
NPI:1962631127
Name:SLOMA, CHANTA L (DACM, LAC)
Entity type:Individual
Prefix:
First Name:CHANTA
Middle Name:L
Last Name:SLOMA
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:CHANTA
Other - Middle Name:L
Other - Last Name:VAN LAANEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:1040 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1841
Mailing Address - Country:US
Mailing Address - Phone:920-493-0797
Mailing Address - Fax:
Practice Address - Street 1:217 N 4TH AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2405
Practice Address - Country:US
Practice Address - Phone:920-493-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI626-55171100000X
WI626-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist