Organization
WATERTOWN CHIROPRACTIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY C FRUENDT DC (PRESIDENT WATERTOWN CHIROPRACTIC)
(920) 261-2204
Entity
Organization
Contact information
Practice address
615 E MAIN ST, SUITE B, WATERTOWN, WI 53094-3200
(920) 261-2204
(920) 261-3901
Mailing address
615 E MAIN ST, SUITE B, WATERTOWN, WI 53094-3200
(920) 261-2204
(920) 261-3901
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3037012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000035420
MEDICARE ID
WI
05
—
38992600
—
WI
Enumeration date
07/15/2006
Last updated
10/04/2016
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