Provider Demographics
NPI:1487793949
Name:HUNSTAD, ERIC PEDER (LAC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:PEDER
Last Name:HUNSTAD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 GARDEN STREET
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3268
Mailing Address - Country:US
Mailing Address - Phone:321-225-4565
Mailing Address - Fax:321-225-4577
Practice Address - Street 1:1508 GARDEN STREET
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3268
Practice Address - Country:US
Practice Address - Phone:321-225-4565
Practice Address - Fax:321-225-4577
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1849171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist