Provider Demographics
NPI:1043257504
Name:CHADRON CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:CHADRON CHIROPRACTIC, P.C.
Other - Org Name:CHADRON CHIROPRACTIC CLINIC, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:G
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-432-3518
Mailing Address - Street 1:279 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2355
Mailing Address - Country:US
Mailing Address - Phone:308-432-3518
Mailing Address - Fax:
Practice Address - Street 1:279 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2355
Practice Address - Country:US
Practice Address - Phone:308-432-3518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1046111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025769400Medicaid
NE10025769400Medicaid