Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038013214 | IL |
N | 111NN0400X | Neurology | 5388-12 | WI |
NPI | 1245720291 |
---|---|
Provider Name | Dr. John Leonard Staranko |
First Address | Sterling, IL 61081-3722 |
Second Address | Janesville, WI 53548-3859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2018 |
Last Update Date | 22/07/2019 |