Provider Demographics
NPI:1235103565
Name:NILLES, ROBERT GERALD (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GERALD
Last Name:NILLES
Suffix:
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 1:12411 W CENTER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3951
Mailing Address - Country:US
Mailing Address - Phone:402-505-4414
Mailing Address - Fax:402-614-9806
Practice Address - Street 1:12411 W CENTER RD STE 105
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3951
Practice Address - Country:US
Practice Address - Phone:402-505-4414
Practice Address - Fax:402-614-9806
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1804111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1147819Medicaid
IAIB1149Medicare PIN
NENA2612Medicare Oscar/Certification
IA1147819Medicaid