Provider Demographics
NPI:1124228192
Name:STINNETTE CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:STINNETTE CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:STINNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-721-0336
Mailing Address - Street 1:2155 E 23RD AVE S
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-7849
Mailing Address - Country:US
Mailing Address - Phone:402-721-0336
Mailing Address - Fax:402-721-8672
Practice Address - Street 1:2155 E 23RD AVE S
Practice Address - Street 2:SUITE A
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-7849
Practice Address - Country:US
Practice Address - Phone:402-721-0336
Practice Address - Fax:402-721-8672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09517OtherBLUE CROSS BLUE SHIELD
NE100251876-00Medicaid
NE09517OtherBLUE CROSS BLUE SHIELD
NE099628Medicare PIN