Provider Demographics
NPI:1306033659
Name:BRENT GERINGER
Entity Type:Organization
Organization Name:BRENT GERINGER
Other - Org Name:WAHOO CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:GERINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-443-4164
Mailing Address - Street 1:216 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-1812
Mailing Address - Country:US
Mailing Address - Phone:402-443-4164
Mailing Address - Fax:
Practice Address - Street 1:216 W 3RD ST
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-1812
Practice Address - Country:US
Practice Address - Phone:402-443-4164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
090366Medicare PIN