Provider Demographics
NPI:1346215662
Name:SVOBODA, SHAWN ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ALLEN
Last Name:SVOBODA
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 1:306 S. 4TH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-2108
Mailing Address - Country:US
Mailing Address - Phone:402-643-4244
Mailing Address - Fax:402-643-4255
Practice Address - Street 1:306 S. 4TH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2108
Practice Address - Country:US
Practice Address - Phone:402-643-4244
Practice Address - Fax:402-643-4255
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09758OtherBLUE CROSS BLUE SHIELD
NE201372646OtherTAX ID FOR REST INSURANCE
NE244908OtherMIDLAND CHOICE
NE10025190800Medicaid
NE09758OtherBLUE CROSS BLUE SHIELD
NE278258Medicare ID - Type Unspecified