Provider Demographics
NPI:1790863264
Name:JANSSEN, JOHN PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PETER
Last Name:JANSSEN
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 1:1524 UNIVERSITY AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-1800
Mailing Address - Country:US
Mailing Address - Phone:920-435-1333
Mailing Address - Fax:
Practice Address - Street 1:1524 UNIVERSITY AVE STE 7
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-1800
Practice Address - Country:US
Practice Address - Phone:920-435-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3049111N00000X
IAAO5755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34572Medicare ID - Type Unspecified
U48954Medicare UPIN