1639240351 NPI number — CHIROPRACTIC HEALTH CLINIC OF MILLARD

Table of content: (NPI 1639240351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639240351 NPI number — CHIROPRACTIC HEALTH CLINIC OF MILLARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPRACTIC HEALTH CLINIC OF MILLARD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639240351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2727 S 144TH ST
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68144-5225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-778-5470
Provider Business Mailing Address Fax Number:
402-778-5471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2727 S 144TH ST
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68144-5225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-778-5470
Provider Business Practice Location Address Fax Number:
402-778-5471
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EILER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
BRIAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
402-778-5470

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  782 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36654 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 125329700 . This is a "FEDERAL WORK COMP PROV #" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: DN4652 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4400188 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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