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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