Provider Demographics
NPI:1437383114
Name:POMAJZL CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:POMAJZL CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:POMAJZL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-381-5554
Mailing Address - Street 1:3008 W STOLLEY PARK RD
Mailing Address - Street 2:STE 3
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-7493
Mailing Address - Country:US
Mailing Address - Phone:308-381-5554
Mailing Address - Fax:308-382-0839
Practice Address - Street 1:3008 W STOLLEY PARK RD
Practice Address - Street 2:STE 3
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-7493
Practice Address - Country:US
Practice Address - Phone:308-381-5554
Practice Address - Fax:308-382-0839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-00Medicaid
T7-1371Medicare UPIN