Provider Demographics
NPI:1083876346
Name:WAYNE SPORT & SPINE, P.C.
Entity Type:Organization
Organization Name:WAYNE SPORT & SPINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:KRUGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-375-3000
Mailing Address - Street 1:214 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NE
Mailing Address - Zip Code:68787-1902
Mailing Address - Country:US
Mailing Address - Phone:402-375-3000
Mailing Address - Fax:
Practice Address - Street 1:214 N PEARL ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NE
Practice Address - Zip Code:68787-1902
Practice Address - Country:US
Practice Address - Phone:402-375-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00307577OtherRAILROAD RETIREMENT MEDICARE
NE36603OtherBLUE CROSS BLUE SHIELD OF NEBRASKA
NE505885989Medicaid
T67267OtherMUTUAL OF OMAHA
T67267OtherMUTUAL OF OMAHA