Provider Demographics
NPI:1982775516
Name:HOEPPNER, FREDERICK JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOHN
Last Name:HOEPPNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 STOUT RD
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2963
Mailing Address - Country:US
Mailing Address - Phone:715-232-0459
Mailing Address - Fax:
Practice Address - Street 1:1503 STOUT RD
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2963
Practice Address - Country:US
Practice Address - Phone:715-232-0459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3179-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU56446Medicare UPIN