Individual
JEROME ALLAN FAGERSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
654 BLUFF ST, BELOIT, WI 53511-6156
(608) 362-7652
(608) 362-7296
Mailing address
654 BLUFF ST, BELOIT, WI 53511-6156
(608) 362-7652
(608) 362-7296
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3406
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38899100
—
WI
Enumeration date
07/15/2006
Last updated
12/10/2015
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