Provider Demographics
NPI:1962593137
Name:PIANO, JOHN CHARLES III (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:PIANO
Suffix:III
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 68
Mailing Address - Street 2:149 EAST WALNUT STREET
Mailing Address - City:OGLESBY
Mailing Address - State:IL
Mailing Address - Zip Code:61348
Mailing Address - Country:US
Mailing Address - Phone:815-883-9630
Mailing Address - Fax:815-883-9631
Practice Address - Street 1:149 EAST WALNUT STREET
Practice Address - Street 2:
Practice Address - City:OGLESBY
Practice Address - State:IL
Practice Address - Zip Code:61348
Practice Address - Country:US
Practice Address - Phone:815-883-9630
Practice Address - Fax:815-883-9631
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
05022672OtherBLUE CROSS BLUE SHIELD
IL548320Medicare ID - Type Unspecified
05022672OtherBLUE CROSS BLUE SHIELD