Provider Demographics
NPI:1396833315
Name:MAUCH, MICHAEL G (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:MAUCH
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 1:4141 PIONEER WOODS DR
Mailing Address - Street 2:STE 116
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7569
Mailing Address - Country:US
Mailing Address - Phone:402-420-0440
Mailing Address - Fax:402-420-0443
Practice Address - Street 1:4141 PIONEER WOODS DR STE 116
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-7569
Practice Address - Country:US
Practice Address - Phone:402-420-0440
Practice Address - Fax:402-420-0443
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025863700Medicaid
NE260913005OtherMEDICARE