1609084367 NPI number — MCCRACKEN CHIROPRACTIC CLINIC, INC

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 1609084367 NPI number — MCCRACKEN CHIROPRACTIC CLINIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCCRACKEN CHIROPRACTIC CLINIC, INC
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:
1609084367
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5740 OLD CHENEY RD
Provider Second Line Business Mailing Address:
SUITE 16
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68516-3544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-421-2277
Provider Business Mailing Address Fax Number:
402-421-7386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5740 OLD CHENEY RD
Provider Second Line Business Practice Location Address:
SUITE 16
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68516-3544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-421-2277
Provider Business Practice Location Address Fax Number:
402-421-7386
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHENEY
Authorized Official First Name:
HEIDI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
402-421-2277

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  658 , 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)





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