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Organization
FOND DU LAC FAMILY CHIROPRACTIC LLC
Active
Organization
FOND DU LAC FAMILY CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT SUPRENAND DC (OWNER)
(920) 872-2969
Entity
Organization
Contact information
Practice address
103 S PIONEER RD STE 200, FOND DU LAC, WI 54935-3800
(208) 722-9639
(920) 933-2511
Mailing address
103 S PIONEER RD STE 200, FOND DU LAC, WI 54935-3800
(920) 872-2969
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4745
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100014403
—
WI
Enumeration date
06/14/2018
Last updated
12/28/2021
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