Provider Demographics
NPI:1235290263
Name:HINRICHS, KELLY EUGENE (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:EUGENE
Last Name:HINRICHS
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 1:11304 DAVENPORT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2630
Mailing Address - Country:US
Mailing Address - Phone:402-934-5830
Mailing Address - Fax:402-934-5831
Practice Address - Street 1:11304 DAVENPORT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2630
Practice Address - Country:US
Practice Address - Phone:402-934-5830
Practice Address - Fax:402-934-5831
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor