=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730228032
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLEUCHAUS CHIROPRACTIC SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2007
-----------------------------------------------------
Last Update Date | 12/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6828 39TH AVE
-----------------------------------------------------
City | KENOSHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53142-7126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-652-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6828 39TH AVE
-----------------------------------------------------
City | KENOSHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53142-7126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-652-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SUSAN L. FLEUCHAUS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 262-652-6000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2998-012
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------