Provider Demographics
NPI:1558517946
Name:BEATRICE FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:BEATRICE FAMILY CHIROPRACTIC, PC
Other - Org Name:CRANDALL CHIROPRACTIC, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRANDALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:402-228-2777
Mailing Address - Street 1:2526 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-3405
Mailing Address - Country:US
Mailing Address - Phone:402-228-2777
Mailing Address - Fax:402-228-2792
Practice Address - Street 1:2526 E COURT ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-3405
Practice Address - Country:US
Practice Address - Phone:402-228-2777
Practice Address - Fax:402-228-2792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025374200Medicaid
NEU80252Medicare UPIN