Active NPI
Justin M. Stanek, MS, ATC
- Athletic Trainer
- Normal, IL
National Provider Identifier
1710907910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 5120 Campus
Normal, IL 61790-5120 - Phone
- (319) 269-8422
- NPI assigned
- Jul 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | IL | Primary |
Addresses
Primary practice location
5120 Campus
Normal, IL 61790-5120
Mailing address
713 W College Ave
Normal, IL 61761-2455
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 096.002073 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710907910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "713 W COLLEGE AVE",
"city": "NORMAL",
"state": "IL",
"postal_code": "617612455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5120 CAMPUS",
"city": "NORMAL",
"state": "IL",
"postal_code": "617905120",
"telephone_number": "319-269-8422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANEK",
"first_name": "JUSTIN",
"middle_name": "M.",
"name_prefix": "Mr.",
"credential": "MS, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Normal, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.