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NPI Code Detail

MEDICARE: MR. JOHN LANDERS HONCHARUK ATC

MEDICARE: MR. JOHN LANDERS HONCHARUK ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer096-000921IL

General Provider Information

NPI Number : 1508853151
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN LANDERS HONCHARUK ATC
Provider Business Mailing Address
First Line : 2671 ASBURY DR
Second Line :
City : AURORA
State : IL
Zip : 60504-3213
Country : US
Telephone Number : 847-343-2579
Fax Number :
Provider Business Practice Location Address
First Line : 1820 W MAIN ST
Second Line :
City : SAINT CHARLES
State : IL
Zip : 60174-1634
Country : US
Telephone Number : 630-928-3400
Fax Number : 630-762-1230
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2005
Last Update Date : 03/03/2010

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