Provider Demographics
NPI:1417164625
Name:CHOICE CARE CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:CHOICE CARE CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:WAIND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-398-1900
Mailing Address - Street 1:2222 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5312
Mailing Address - Country:US
Mailing Address - Phone:308-398-1900
Mailing Address - Fax:308-398-1901
Practice Address - Street 1:2222 W 2ND ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5312
Practice Address - Country:US
Practice Address - Phone:308-398-1900
Practice Address - Fax:308-398-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE99593OtherBLUE CROSS BLUE SHIELD
NE99593OtherBLUE CROSS BLUE SHIELD
NE275650Medicare ID - Type Unspecified
NE99593OtherBLUE CROSS BLUE SHIELD