Provider Demographics
NPI:1003981754
Name:GODFREY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:GODFREY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-331-0392
Mailing Address - Street 1:2281 S 67TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2809
Mailing Address - Country:US
Mailing Address - Phone:402-331-0392
Mailing Address - Fax:402-331-0183
Practice Address - Street 1:2281 S 67TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2809
Practice Address - Country:US
Practice Address - Phone:402-331-0392
Practice Address - Fax:402-331-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1003981754OtherGODFREY CHIROPRACTIC NPI
NE1841283983OtherNPI DR. KATE GODFREY
NE1053304196OtherNPI DR. BRUCE GODFREY
NE1003981754OtherGODFREY CHIROPRACTIC NPI
NEV68670Medicare UPIN
NE=========05Medicaid
NE1053304196OtherNPI DR. BRUCE GODFREY
NE271296Medicare ID - Type UnspecifiedDR. BRUCE GODFREY