1386886273 NPI number — SCHRAGE CHIROPRACTIC PC

Table of content: (NPI 1386886273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386886273 NPI number — SCHRAGE CHIROPRACTIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHRAGE CHIROPRACTIC 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:
1386886273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3675 N 129TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68164-5211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-885-8783
Provider Business Mailing Address Fax Number:
402-885-8794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3675 N 129TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68164-5211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-885-8783
Provider Business Practice Location Address Fax Number:
402-885-8794
Provider Enumeration Date:
03/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official Telephone Number:
402-885-8783

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1073777967 . This is a "COVENTRY" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 258442 . This is a "PRINCIPAL" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 27236 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025738000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 258442 . This is a "MIDLANDS CHOICE/AETNA/CIGNA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1073777967 . This is a "SANFORD HEALTH PLAN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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