Provider Demographics
NPI:1962454058
Name:JANESHAK, WILLIAM GLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GLEN
Last Name:JANESHAK
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 1:19762 YORBA LINDA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2801
Mailing Address - Country:US
Mailing Address - Phone:714-777-2500
Mailing Address - Fax:714-777-1829
Practice Address - Street 1:19762 YORBA LINDA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2801
Practice Address - Country:US
Practice Address - Phone:714-777-2500
Practice Address - Fax:714-777-1829
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24426Medicare ID - Type UnspecifiedCHIROPRACTIC