Provider Demographics
NPI:1457443699
Name:IVERSON, CASEY J (DC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:J
Last Name:IVERSON
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:PO BOX 2371
Mailing Address - Street 2:1804 WEST FORREST STREET
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-2371
Mailing Address - Country:US
Mailing Address - Phone:308-382-3666
Mailing Address - Fax:308-382-3644
Practice Address - Street 1:1804 WEST FORREST STREET
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68802-2110
Practice Address - Country:US
Practice Address - Phone:308-382-3666
Practice Address - Fax:308-382-3644
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09538OtherBCBS
NE47068753000Medicaid
NE47-068753000Medicaid
NE22491OtherMIDLANDS CHOICE
NE47-068753000Medicaid
NE09538OtherBCBS
NE091511Medicare Oscar/Certification