Provider Demographics
NPI:1467400879
Name:JANUSKI, THOMAS J (CH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:JANUSKI
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 N MONTEZUMA
Mailing Address - Street 2:STE A
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2090
Mailing Address - Country:US
Mailing Address - Phone:928-778-0147
Mailing Address - Fax:928-778-0772
Practice Address - Street 1:728 N MONTEZUMA ST
Practice Address - Street 2:STE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2090
Practice Address - Country:US
Practice Address - Phone:928-778-0147
Practice Address - Fax:928-778-0772
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0930060OtherBCBS
AZZ61770Medicare PIN
AZ0930060OtherBCBS