FENANDER CHIROPRACTIC OFFICE S.C.

Provider Demographics

• NPI: 1760541767
• Name: FENANDER CHIROPRACTIC OFFICE S.C.
• Entity Type: Organization
• Organization Name: FENANDER CHIROPRACTIC OFFICE S.C.
• Authorized Official - Title/Position: VICE PRESIDENT
• Authorized Official - Prefix: DR
• Authorized Official - First Name: LAURA
• Authorized Official - Middle Name: J
• Authorized Official - Last Name: FENANDER
• Authorized Official - Credentials: DC
• Authorized Official - Phone: 715-421-2200
• Mailing Address - Street 1: 2100 7TH ST S
• Mailing Address - City: WISCONSIN RAPIDS
• Mailing Address - State: WI
• Mailing Address - Zip Code: 54494-6017
• Mailing Address - Country: US
• Mailing Address - Phone: 715-421-2200
• Mailing Address - Fax: 715-421-2916
• Practice Address - Street 1: 2100 7TH ST S
• Practice Address - City: WISCONSIN RAPIDS
• Practice Address - State: WI
• Practice Address - Zip Code: 54494-6017
• Practice Address - Country: US
• Practice Address - Phone: 715-421-2200
• Practice Address - Fax: 715-421-2916
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-12-06
• Last Update Date: 2020-08-22

Provider Licenses

State	License ID	Taxonomies
WI	1214-012	111N00000X
WI	2537-012	111N00000X
WI	3812-012	111N00000X
WI	1685-012	111N00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	111N00000X	Chiropractic Providers	Chiropractor		Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WI	387728664005	Other	L.J.FENANDER,D.C. BC#
WI	388343467006	Other	A.V.FENANDER,D.C. BC#
WI	1295705366	Other	NATIONAL PROVIDER ID
WI	1710957881	Other	L. J. FENANDER, D.C. NPI#
WI	1992775076	Other	M.F.LADICK,D.C. NPI#
WI	387728809001	Other	M.A.FENANDER,D.C. BC#
WI	394568499005	Other	M.F.LADICK,D.C. BC#
WI	38770600	Medicaid
WI	38809500	Medicaid
WI	1104896869	Other	M.A.FENANDER,D.C. NPI
WI	38844700	Medicaid
WI	38935700	Medicaid
WI	T62525	Medicare UPIN
WI	38770600	Medicaid
WI	387728809001	Other	M.A.FENANDER,D.C. BC#
WI	U88237	Medicare UPIN