Provider Demographics
NPI:1073519112
Name:HONACKI, JOHN JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:HONACKI
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 1:20280 ROUTE 19
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6125
Mailing Address - Country:US
Mailing Address - Phone:724-776-5095
Mailing Address - Fax:724-776-5175
Practice Address - Street 1:20280 ROUTE 19
Practice Address - Street 2:UNIT 2
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6125
Practice Address - Country:US
Practice Address - Phone:724-776-5095
Practice Address - Fax:724-776-5175
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-002304-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA94379Medicaid
PAHO-128729OtherBLUE CROSS BLUE SHIELD
PA94379Medicaid
PAHO-128729OtherBLUE CROSS BLUE SHIELD