Provider Demographics
NPI:1578342226
Name:BENNINGTON SPINE
Entity Type:Organization
Organization Name:BENNINGTON SPINE
Other - Org Name:YOUNG CHIROPRACTIC & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-707-4897
Mailing Address - Street 1:11550 S 119TH CIR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-5921
Mailing Address - Country:US
Mailing Address - Phone:402-415-7426
Mailing Address - Fax:
Practice Address - Street 1:15530 IDA ST STE 400
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-1402
Practice Address - Country:US
Practice Address - Phone:402-339-2283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty