Fond Du Lac Family Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4745 Issued in WI

Legal business name

FOND DU LAC FAMILY CHIROPRACTIC LLC

Practice address

103 S Pioneer Rd Ste 200
Fond Du Lac, WI 54935-3800

Phone

(208) 722-9639

Fax

(920) 933-2511

NPI assigned

Jun 14, 2018

Last updated

Dec 28, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Scott Suprenand, DCNPI 1083903090

Title

Owner

Phone

(920) 872-2969

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Scott Thomas Suprenand, D.C.

  • Chiropractor
  • Fond Du Lac, WI
  • NPI 1083903090
  Medicare reassignment Care Compare group NPD Authorized official
• Courtney Kitzrow, D.C

  • Chiropractor
  • Fond Du Lac, WI
  • NPI 1619401098
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640649600000",
    "number": "1790278695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 S PIONEER RD STE 200",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353800",
            "telephone_number": "920-872-2969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 S PIONEER RD STE 200",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353800",
            "telephone_number": "208-722-9639",
            "fax_number": "920-933-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOND DU LAC FAMILY CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-14",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A",
        "authorized_official_last_name": "SUPRENAND",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-872-2969",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4745",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100014403",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fond Du Lac County Department of Senior Services
• Fond Du Lac County Dept of Human Services
• Fond Du Lac County DSS
• Fond Du Lac County DSS Personal Care
• Fond Du Lac County Human Service Group Homes
• Fond Du Lac Family Dentistry, LLC
• Fond Du Lac Lutheran Home, Inc. (Tarfa Terrace)
• Fond Du Lac Lutheran Home, Inc. (Fond Du Lac Lutheran Home)
• Fond Du Lac Nursing and Rehab, LLC (Edenbrook of Fond du Lac)
• Fond Du Lac Pathology Consultants

• Chiropractor in Fond Du Lac, WI
• Providers in Fond Du Lac, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.