Provider Demographics
NPI:1003184045
Name:EAGLE RUN CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:EAGLE RUN CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-491-4087
Mailing Address - Street 1:13808 W MAPLE RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-6231
Mailing Address - Country:US
Mailing Address - Phone:402-491-4087
Mailing Address - Fax:402-491-4091
Practice Address - Street 1:13808 W MAPLE RD
Practice Address - Street 2:SUITE 116
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-6231
Practice Address - Country:US
Practice Address - Phone:402-491-4087
Practice Address - Fax:402-491-4091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
270993Medicare PIN