=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376256073
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JERANEK FAMILY CHIROPRACTIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2022
-----------------------------------------------------
Last Update Date | 12/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7505 41ST AVE
-----------------------------------------------------
City | KENOSHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53142-4368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-694-7833
-----------------------------------------------------
Fax | 262-694-7907
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7505 41ST AVE
-----------------------------------------------------
City | KENOSHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53142-4368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-694-7833
-----------------------------------------------------
Fax | 262-694-7907
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JANET JERANEK DELGRECO
-----------------------------------------------------
Credential | BSDC
-----------------------------------------------------
Telephone | 262-694-7833
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------