Provider Demographics
NPI:1114196813
Name:PRICE, MICHAEL JAY JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAY
Last Name:PRICE
Suffix:JR
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 1:16909 BURKE ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2268
Mailing Address - Country:US
Mailing Address - Phone:402-933-4463
Mailing Address - Fax:402-763-6923
Practice Address - Street 1:16909 BURKE ST
Practice Address - Street 2:SUITE 124
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2268
Practice Address - Country:US
Practice Address - Phone:402-933-4463
Practice Address - Fax:402-763-6923
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor