Provider Demographics
NPI:1841303450
Name:BJERKE, JOHN ARLEN (DC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ARLEN
Last Name:BJERKE
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 1:820 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665
Mailing Address - Country:US
Mailing Address - Phone:608-637-7177
Mailing Address - Fax:608-637-7177
Practice Address - Street 1:820 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665
Practice Address - Country:US
Practice Address - Phone:608-637-7177
Practice Address - Fax:608-637-7177
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1490012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38764500Medicaid
WI38764500Medicaid
T90484Medicare UPIN