Fagerstrom, Jerome Allan
Fagerstrom, Jerome Allan is an individual health care provider with primary practice located at 654 Bluff St , Beloit WI 53511-6156. He recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as his primary health care specialty. Fagerstrom, Jerome Allan can be contacted via phone (608) 362-7652.Contact Information
Primary practice address
654 Bluff St
Beloit WI 53511-6156
Phone: (608) 362-7652
Fax: (608) 362-7296
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Chiropractor | 111N00000X | 3406 | Wisconsin |
Profile Details
| NPI number | 1205852738 |
|---|---|
| LBN Legal business name | Fagerstrom, Jerome Allan |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 15th, 2006 |
| Last updated | Dec 10th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1205852738 | NPPES |
| Wisconsin | MEDICAID | 38899100 |
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