IDEAL CHIROPRACTIC OF FOND DU LAC LLC (NPI# 1639351026) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639351026 |
| Entity Type | Organization |
| Organization Name | IDEAL CHIROPRACTIC OF FOND DU LAC LLC |
| Practice Address |
976 E Johnson St Ste 900 Fond Du Lac WI 54935-9747 |
| Practice Telephone | 9209071700 |
| Practice Fax Number | 9209071708 |
| Mailing Telephone | 9209071700 |
| Mailing Fax Number | 9209071708 |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2007-11-28 |
| Authorized Official Name | DR. JESSICA LYNN RODRIGUEZ (DOCTOR OF CHIROPRACTIC) |
| Authorized Official Telephone | 9209071700 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 4174-012 | WI | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | INDIVIDUAL NPI | 1063589505 | 01 |
| Street Address |
976 E JOHNSON ST STE 900 |
| City | FOND DU LAC |
| State | WI |
| Zip Code | 54935-9747 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467877837 | No Knots Therapeutic Massage | Massage Therapist | 976 E Johnson St Ste 900, Fond Du Lac, WI 54935-9747 | 2014-02-21 |
| 1427473883 | Rebecca Vanderloop | Massage Therapist | 976 E Johnson St Ste 900, Fond Du Lac, WI 54935-9747 | 2014-02-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609482249 | Keziah Sherri Love | Counselor | W390 Wi-23, Fond Du Lac, WI 54935 | 2020-09-18 |
| 1891341988 | Cynthia Louise Singleton | Nurse Practitioner | 16 E 13th St., Fond Du Lac, WI 54935 | 2019-08-14 |
| 1083183297 | Elena Alexandra Giese | Nurse Practitioner | 430 E. Division St, Fond Du Lac, WI 54935 | 2018-11-16 |
| 1669963740 | Elizabeth Anne Machi | Student in an Organized Health Care Education/Training Program | 885 Western Ave Ste 300, Fond Du Lac, WI 54935 | 2018-05-23 |
| 1184150021 | Jordan Moehn | Specialist/Technologist | 633 Prairie Pkwy, Fond Du Lac, WI 54935 | 2017-05-11 |
| 1467856336 | Chuentao Ho | Specialist/Technologist | 45 South National Ave., Fond Du Lac, WI 54935 | 2014-10-21 |
| 1437587961 | Paula Seeley | Nurse Practitioner | 63 West Pioneer Rd, Fond Du Lac, WI 54935 | 2013-10-18 |
| 1144516030 | Bonnie Kay Mallon | Registered Nurse | 118 E 9th St, Fond Du Lac, WI 54935 | 2011-06-20 |
| 1770885600 | Holly Shepard | Counselor | 23 W Scott St., Fond Du Lac, WI 54935 | 2010-11-29 |
| 1437479110 | Ruth Marie Bohn | Occupational Therapy Assistant | 244 North Macy Street, Fond Du Lac, WI 54935 | 2010-06-04 |
| Find all providers in zip 54935 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790278695 | Fond Du Lac Family Chiropractic LLC | Chiropractor | 924 Forest Ave Ste 101, Fond Du Lac, WI 54935-3808 | 2018-06-14 |
| 1154594059 | Moxon Chiropractic, S.c. | Chiropractor | 93 S Pioneer Rd, 200, Fond Du Lac, WI 54935-3873 | 2008-04-11 |
| 1437289972 | Richard Lee Moxon | Chiropractor | 93 S Pioneer Rd Ste 200, Fond Du Lac, WI 54936-1776 | 2007-03-06 |
| 1346385499 | Bret Zachary Johnson | Chiropractor | 195 East 14th St, Fond Du Lac, WI 54936-1451 | 2007-02-20 |
| 1407991573 | Timothy Johnson | Chiropractor | 195 East 14th St., Fond Du Lac, WI 54936-1451 | 2007-02-20 |
| 1386785574 | James A Early | Chiropractor | 1211 Rickmeyer Dr, Fond Du Lac, WI 54937-2213 | 2007-02-09 |
| 1063589505 | Jessica L Serwe | Chiropractor | 976 E Johnson St, Suite 900, Fond Du Lac, WI 54935-9746 | 2006-11-29 |
| 1174629026 | Vickie L Goldapske | Chiropractor | 952 South Park Avenue, Fond Du Lac, WI 54935 | 2006-09-16 |
| 1265464192 | Daniel Dean Farina | Chiropractor | 85 N Pioneer Rd, Fond Du Lac, WI 54935-9400 | 2006-07-07 |
| 1063444982 | Shayne Michael Bauer | Chiropractor | 355 N Peters Ave., Fond Du Lac, WI 54935-9400 | 2006-07-07 |
| Find all providers in FOND DU LAC | ||||
| City | FOND DU LAC |
| Zip Code | 54935 |
Please comment or provide details below to improve the information on IDEAL CHIROPRACTIC OF FOND DU LAC LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.