1023116928 NPI number — FUNK FAMILY CHIROPRACTIC LLC

Table of content: (NPI 1023116928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023116928 NPI number — FUNK FAMILY CHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FUNK FAMILY 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:
1023116928
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:
17660 WRIGHT ST.
Provider Second Line Business Mailing Address:
SUITE 11
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68130-2096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-934-3500
Provider Business Mailing Address Fax Number:
402-934-3577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17660 WRIGHT ST.
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68130-2096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-934-3500
Provider Business Practice Location Address Fax Number:
402-934-3577
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FUNK
Authorized Official First Name:
JASON
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
402-934-3500

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1224 , 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: 10025430800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com