Provider Demographics
NPI:1467182170
Name:FLACK CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FLACK CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-541-2920
Mailing Address - Street 1:17940 WELCH PLZ STE 2
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3714
Mailing Address - Country:US
Mailing Address - Phone:531-999-2080
Mailing Address - Fax:
Practice Address - Street 1:17940 WELCH PLZ STE 2
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3714
Practice Address - Country:US
Practice Address - Phone:531-999-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty