Provider Demographics
NPI:1356474860
Name:JANOVICK FAMILY CHIROPRACTIC SC
Entity type:Organization
Organization Name:JANOVICK FAMILY CHIROPRACTIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:JANOVICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-398-8803
Mailing Address - Street 1:5919 TOWER AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-7226
Mailing Address - Country:US
Mailing Address - Phone:715-398-8803
Mailing Address - Fax:715-398-8804
Practice Address - Street 1:5919 TOWER AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-7226
Practice Address - Country:US
Practice Address - Phone:715-398-8803
Practice Address - Fax:715-398-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2851-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI013R4JAOtherBCBS INDIVIDUAL NUMBER
WI63I47JAOtherBCBS GROUP NUMBER
WI38866100Medicaid
WI2851-012OtherWI LICENSE
MN628822OtherCHIROCARE OF MN
MN628822OtherCHIROCARE OF MN