Provider Demographics
NPI:1477830883
Name:JANNING, JACK THOMAS (DC, ATC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:THOMAS
Last Name:JANNING
Suffix:
Gender:M
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:GLIDDEN
Mailing Address - State:IA
Mailing Address - Zip Code:51443-1035
Mailing Address - Country:US
Mailing Address - Phone:712-830-3153
Mailing Address - Fax:
Practice Address - Street 1:202 S IDAHO ST
Practice Address - Street 2:
Practice Address - City:GLIDDEN
Practice Address - State:IA
Practice Address - Zip Code:51443-1035
Practice Address - Country:US
Practice Address - Phone:712-830-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor