Provider Demographics
NPI:1871656801
Name:JURACK, JANICE (DC)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:JURACK
Suffix:
Gender:F
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:S69 W15689 JANESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-7947
Mailing Address - Country:US
Mailing Address - Phone:414-422-1203
Mailing Address - Fax:414-425-1225
Practice Address - Street 1:S69 W15689 JANESVILLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-7947
Practice Address - Country:US
Practice Address - Phone:414-422-1203
Practice Address - Fax:414-425-1225
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3485 012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391917079017OtherBLUE CROSS
WI391917079OtherCOMMERCIAL
WI391917079OtherCOMMERCIAL
WIU70146Medicare UPIN