Healthcare Provider Details

I. General information

NPI: 1467381715
Provider Name (Legal Business Name): FOND DU LAC ACUPUNCTURE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 WESTERN AVE STE 500
FOND DU LAC WI
54935-3880
US

IV. Provider business mailing address

885 WESTERN AVE STE 500
FOND DU LAC WI
54935-3880
US

V. Phone/Fax

Practice location:
  • Phone: 920-602-7915
  • Fax: 920-273-3776
Mailing address:
  • Phone: 920-602-7915
  • Fax: 920-273-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KARI COBB
Title or Position: OWNER/EMPLOYEE
Credential: DACM
Phone: 920-602-7915