Provider Demographics
NPI:1992099055
Name:HAUSMANN, ROSS ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:ROBERT
Last Name:HAUSMANN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 BOYSON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2336
Mailing Address - Country:US
Mailing Address - Phone:319-393-4264
Mailing Address - Fax:
Practice Address - Street 1:1625 BOYSON RD STE 104
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233
Practice Address - Country:US
Practice Address - Phone:319-393-4264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4687012111N00000X
IA007366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1992099055Medicaid
WI704700011Medicare PIN