Provider Demographics
NPI:1154351237
Name:JANUSZ, RAYMOND M (DC)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:M
Last Name:JANUSZ
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:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53008-0666
Mailing Address - Country:US
Mailing Address - Phone:414-643-6000
Mailing Address - Fax:414-643-6400
Practice Address - Street 1:2727 W CLEVELAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-2956
Practice Address - Country:US
Practice Address - Phone:414-643-6000
Practice Address - Fax:414-643-6400
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2411-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38859800Medicaid
WI38859800Medicaid
WIT95796Medicare UPIN