1093951451 NPI number — HEALTHY START CHIROPRACTIC & WELLNESS, PC

Table of content: (NPI 1093951451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093951451 NPI number — HEALTHY START CHIROPRACTIC & WELLNESS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHY START CHIROPRACTIC & WELLNESS, PC
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:
1093951451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5710 S 53RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68516-3276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-423-4325
Provider Business Mailing Address Fax Number:
402-904-4223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5710 S 53RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68516-3276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-309-4963
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEONIDA
Authorized Official First Name:
TIFFANY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER/PRESIDENT/CHIROPRACTOR
Authorized Official Telephone Number:
402-423-4325

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1543 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 1542 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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