Healthcare Provider Details

I. General information

NPI: 1942503370
Provider Name (Legal Business Name): JANECEK CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N JACKSON ST
FAIRBURY IL
61739-1040
US

IV. Provider business mailing address

505 N JACKSON ST
FAIRBURY IL
61739-1040
US

V. Phone/Fax

Practice location:
  • Phone: 309-838-3835
  • Fax:
Mailing address:
  • Phone: 309-838-3835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-003756
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID EDWARD JANECEK
Title or Position: OWNER
Credential: DC
Phone: 815-692-4420