1467603464 NPI number — ADVANCED CHIROPRACTIC & NEUROLOGY, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467603464 NPI number — ADVANCED CHIROPRACTIC & NEUROLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED CHIROPRACTIC & NEUROLOGY, 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:
1467603464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12040 MCDERMOTT PLZ
Provider Second Line Business Mailing Address:
STE 320
Provider Business Mailing Address City Name:
LA VISTA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68128-2354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-597-2869
Provider Business Mailing Address Fax Number:
402-597-2536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12040 MCDERMOTT PLZ
Provider Second Line Business Practice Location Address:
STE 320
Provider Business Practice Location Address City Name:
LA VISTA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68128-2354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-597-2869
Provider Business Practice Location Address Fax Number:
402-597-2536
Provider Enumeration Date:
10/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCCLAREN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-597-2869

Provider Taxonomy Codes

  • Taxonomy code: 111NN0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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