Provider Demographics
NPI:1467755801
Name:FOSSO GELHAR CHIROPRACTORS OF THE FOX VALLEY
Entity Type:Organization
Organization Name:FOSSO GELHAR CHIROPRACTORS OF THE FOX VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSOO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-426-2718
Mailing Address - Street 1:3466 SHEPPARD DR
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-6915
Mailing Address - Country:US
Mailing Address - Phone:920-426-2718
Mailing Address - Fax:
Practice Address - Street 1:5111A GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-9794
Practice Address - Country:US
Practice Address - Phone:920-230-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3365012111N00000X
WI4026012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty