Provider Demographics
NPI:1598906422
Name:RIVER VALLEY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:RIVER VALLEY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KASSANDRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BERTHOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-534-5840
Mailing Address - Street 1:PO BOX 1752
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103-1752
Mailing Address - Country:US
Mailing Address - Phone:308-534-5840
Mailing Address - Fax:308-534-1531
Practice Address - Street 1:1717 EAST 4TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-4392
Practice Address - Country:US
Practice Address - Phone:308-534-5840
Practice Address - Fax:308-534-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1544261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
3024Medicare PIN
NA1345Medicare PIN