Provider Demographics
NPI:1902962681
Name:WARNECKE, JON KARL (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:KARL
Last Name:WARNECKE
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 1:30 N AYER ST
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033
Mailing Address - Country:US
Mailing Address - Phone:815-943-9150
Mailing Address - Fax:815-943-6122
Practice Address - Street 1:30 N AYER ST
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033
Practice Address - Country:US
Practice Address - Phone:815-943-9150
Practice Address - Fax:815-943-6122
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0002048012111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL983760Medicare ID - Type Unspecified
0001682445Medicare UPIN