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Organization
IDEAL CHIROPRACTIC OF FOND DU LAC LLC
Active
Organization
IDEAL CHIROPRACTIC OF FOND DU LAC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSICA LYNN RODRIGUEZ DC (DOCTOR OF CHIROPRACTIC)
(920) 907-1700
Entity
Organization
Contact information
Practice address
976 E JOHNSON ST STE 900, FOND DU LAC, WI 54935-9747
(920) 907-1700
(920) 907-1708
Mailing address
976 E JOHNSON ST STE 900, FOND DU LAC, WI 54935-9747
(920) 907-1700
(920) 907-1708
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4174-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063589505
INDIVIDUAL NPI
WI
Enumeration date
11/28/2007
Last updated
11/28/2007
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