Provider Demographics
NPI:1447415088
Name:MCKILLICAN CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:MCKILLICAN CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JON
Authorized Official - Last Name:MCKILLICAN
Authorized Official - Suffix:
Authorized Official - Credentials:D,C,
Authorized Official - Phone:402-493-4333
Mailing Address - Street 1:5660 N 103RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1007
Mailing Address - Country:US
Mailing Address - Phone:402-493-4333
Mailing Address - Fax:402-493-4334
Practice Address - Street 1:5660 N 103RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1007
Practice Address - Country:US
Practice Address - Phone:402-493-4333
Practice Address - Fax:402-493-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE99501OtherBC/BS
NE=========Medicaid
NE273519Medicare UPIN