Provider Demographics
NPI:1679690473
Name:STAGG, JOHN C (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:STAGG
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 1:2100 E MILWAUKEE ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-2182
Mailing Address - Country:US
Mailing Address - Phone:608-756-3434
Mailing Address - Fax:
Practice Address - Street 1:2100 E MILWAUKEE ST
Practice Address - Street 2:SUITE 18
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-2182
Practice Address - Country:US
Practice Address - Phone:608-756-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor