1851507578 NPI number — ELKHORN CHIROPRACTIC LLC

Table of content: (NPI 1851507578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851507578 NPI number — ELKHORN CHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELKHORN CHIROPRACTIC LLC
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:
1851507578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20214 VETERANS DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
ELKHORN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68022-6900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-359-1422
Provider Business Mailing Address Fax Number:
402-359-1424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20214 VETERANS DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ELKHORN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68022-6900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-359-1422
Provider Business Practice Location Address Fax Number:
402-359-1424
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KELLEY
Authorized Official First Name:
KURT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
402-359-1422

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1377 , 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: 1134120785 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 246973 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 09803 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 100253167-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 264433 . This is a "COVENTRY" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com