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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