Provider Demographics
NPI:1184786956
Name:JERANEK-DELGRECO, JANET L (DC)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:JERANEK-DELGRECO
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 1:7505 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-4368
Mailing Address - Country:US
Mailing Address - Phone:262-694-7833
Mailing Address - Fax:262-694-7907
Practice Address - Street 1:7505 41ST AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-4368
Practice Address - Country:US
Practice Address - Phone:262-694-7833
Practice Address - Fax:262-694-7907
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3181-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38886500Medicaid
WI38886500Medicaid
WI000035272Medicare PIN