Provider Demographics
NPI:1114936366
Name:A CENTER FOR CHIROPRACTIC & ALTERNATIVE MEDICINE PC
Entity Type:Organization
Organization Name:A CENTER FOR CHIROPRACTIC & ALTERNATIVE MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:THANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-316-9733
Mailing Address - Street 1:1800 W PASEWALK STE 102
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701
Mailing Address - Country:US
Mailing Address - Phone:402-371-4673
Mailing Address - Fax:402-371-7431
Practice Address - Street 1:1800 W PASEWALK STE 102
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701
Practice Address - Country:US
Practice Address - Phone:402-371-4673
Practice Address - Fax:402-371-7431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025275900Medicaid
NE099718Medicare ID - Type UnspecifiedMEDICARE GROUP #