Provider Demographics
NPI:1134172166
Name:JAVUREK, GABRIEL JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:JOHN
Last Name:JAVUREK
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 1:1800 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008
Mailing Address - Country:US
Mailing Address - Phone:815-544-9298
Mailing Address - Fax:815-547-3416
Practice Address - Street 1:1800 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008
Practice Address - Country:US
Practice Address - Phone:815-544-9298
Practice Address - Fax:815-547-3416
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002163A111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN229100BMedicare ID - Type Unspecified
V04792Medicare UPIN