Healthcare Provider Details

I. General information

NPI: 1972001055
Provider Name (Legal Business Name): MADISON BLAIR HOPFENSPERGER DC, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON BLAIR RESCH ATC

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 09/10/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 S COMMERCIAL ST
NEENAH WI
54956-4801
US

IV. Provider business mailing address

1511 S COMMERCIAL ST
NEENAH WI
54956-4801
US

V. Phone/Fax

Practice location:
  • Phone: 920-720-0660
  • Fax: 920-720-0666
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5683-12
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2422-39
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: