Provider Demographics
NPI:1265719678
Name:JANNING CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:JANNING CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:JANNING
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ATC
Authorized Official - Phone:712-830-3153
Mailing Address - Street 1:202 S IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:GLIDDEN
Mailing Address - State:IA
Mailing Address - Zip Code:51443-1035
Mailing Address - Country:US
Mailing Address - Phone:712-830-3153
Mailing Address - Fax:
Practice Address - Street 1:202 S IDAHO ST
Practice Address - Street 2:
Practice Address - City:GLIDDEN
Practice Address - State:IA
Practice Address - Zip Code:51443-1035
Practice Address - Country:US
Practice Address - Phone:712-830-3153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty