Provider Demographics
NPI:1326252008
Name:BLUFFS CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:BLUFFS CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOK
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:BOWHAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-632-7094
Mailing Address - Street 1:226 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4625
Mailing Address - Country:US
Mailing Address - Phone:308-632-7094
Mailing Address - Fax:308-632-2961
Practice Address - Street 1:226 W 38TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4625
Practice Address - Country:US
Practice Address - Phone:308-632-7094
Practice Address - Fax:308-632-2961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE861111N00000X
NE847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NET40208Medicare UPIN
NE091546WHMedicare ID - Type Unspecified
NET40207Medicare UPIN
NE091547BOMedicare ID - Type Unspecified