Provider Demographics
NPI:1215229109
Name:DOERNEMAN, CHAD D (PT)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:D
Last Name:DOERNEMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:119 N 51ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2867
Practice Address - Country:US
Practice Address - Phone:102-506-5695
Practice Address - Fax:402-596-6758
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47627OtherBLUE CROSS BLUE SHIELD
NEP01003067OtherRAILROAD MEDICARE
NE47627OtherBLUE CROSS BLUE SHIELD