Provider Demographics
NPI:1376565655
Name:GROENE, JEFFREY SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:GROENE
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 1:410 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SCHUYLER
Mailing Address - State:NE
Mailing Address - Zip Code:68661-1348
Mailing Address - Country:US
Mailing Address - Phone:402-352-3399
Mailing Address - Fax:402-352-3099
Practice Address - Street 1:410 W 16TH ST
Practice Address - Street 2:
Practice Address - City:SCHUYLER
Practice Address - State:NE
Practice Address - Zip Code:68661-1348
Practice Address - Country:US
Practice Address - Phone:402-352-3399
Practice Address - Fax:402-352-3099
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1376565655Medicare UPIN
COU71867Medicare UPIN
CO806313Medicare PIN
CO806313Medicare PIN