Provider Demographics
NPI:1457658304
Name:FLETCHER, KIMBERLY CONN (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:CONN
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N KOELLER ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-4111
Mailing Address - Country:US
Mailing Address - Phone:920-230-2800
Mailing Address - Fax:920-651-4289
Practice Address - Street 1:440 N KOELLER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4111
Practice Address - Country:US
Practice Address - Phone:920-230-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4720-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038011833OtherILLINOIS DEPARTMENT OF PROFESSIONAL REGULATION
WI4720-12OtherWISCONSIN DEPARTMENT OF REGULATION AND LICENSING