1760541767 NPI number — FENANDER CHIROPRACTIC OFFICE S.C.

Table of content: (NPI 1760541767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760541767 NPI number — FENANDER CHIROPRACTIC OFFICE S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FENANDER CHIROPRACTIC OFFICE S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760541767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 7TH ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WISCONSIN RAPIDS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54494-6017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-421-2200
Provider Business Mailing Address Fax Number:
715-421-2916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 7TH ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WISCONSIN RAPIDS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54494-6017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-421-2200
Provider Business Practice Location Address Fax Number:
715-421-2916
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FENANDER
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
715-421-2200

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1214-012 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 2537-012 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 3812-012 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 1685-012 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 387728664005 . This is a "L.J.FENANDER,D.C. BC#" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 388343467006 . This is a "A.V.FENANDER,D.C. BC#" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1295705366 . This is a "NATIONAL PROVIDER ID" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1710957881 . This is a "L. J. FENANDER, D.C. NPI#" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1992775076 . This is a "M.F.LADICK,D.C. NPI#" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 387728809001 . This is a "M.A.FENANDER,D.C. BC#" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 394568499005 . This is a "M.F.LADICK,D.C. BC#" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 38770600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38809500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1104896869 . This is a "M.A.FENANDER,D.C. NPI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 38844700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38935700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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