Fond Du Lac Chiropractic & Wellness Center LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4174-012 Issued in WI

Legal business name

FOND DU LAC CHIROPRACTIC & WELLNESS CENTER LLC

Doing business as

Ideal Chiropractic

Practice address

976 E Johnson St
Ste 900
Fond Du Lac, WI 54935-9746

Phone

(920) 907-1700

Fax

(920) 907-1708

NPI assigned

Dec 22, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Jessica Lynn Serwe, DCNPI 1063589505

Title

Clinic Owner

Phone

(920) 907-1700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ideal Chiropractic Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessica L Serwe, DC

  • Chiropractor
  • Fond Du Lac, WI
  • NPI 1063589505
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1229904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237334400000",
    "number": "1902042922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "976 E JOHNSON ST",
            "address_2": "STE 900",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549359746",
            "telephone_number": "920-907-1700",
            "fax_number": "920-907-1708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "976 E JOHNSON ST",
            "address_2": "STE 900",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549359746",
            "telephone_number": "920-907-1700",
            "fax_number": "920-907-1708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOND DU LAC CHIROPRACTIC & WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-22",
        "last_updated": "2009-03-18",
        "status": "A",
        "authorized_official_last_name": "SERWE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CLINIC OWNER",
        "authorized_official_telephone_number": "920-907-1700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4174-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38185900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ideal Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Steven D Flurry, MD
• Kelly Mukti Flynn, CRNA
• FMG East Arndt Street Wisconsin LLC (All About Life Rehabilitation Center)
• Joel A Follmer
• Fond Du Lac Acupuncture Clinic LLC
• Fond Du Lac Co DCP CCS Program
• Fond Du Lac County (Health Care Center)
• Fond Du Lac County (Department of Human Services Clinical Services)
• Fond Du Lac County
• Fond Du Lac County

• 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 Mar 18, 2009; 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.