Provider Demographics
NPI:1053304196
Name:GODFREY, BRUCE SCHOENMAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:SCHOENMAN
Last Name:GODFREY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1003981754OtherGODFREY CHIROPRACTIC NPI
1053304196OtherBRUCE NPI
NE47081684105Medicaid
NE47081684105Medicaid
NE1003981754OtherGODFREY CHIROPRACTIC NPI