Provider Demographics
NPI:1598976508
Name:ELMWOOD CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:ELMWOOD CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GERMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-504-4442
Mailing Address - Street 1:6846 PACIFIC ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-1156
Mailing Address - Country:US
Mailing Address - Phone:402-504-4442
Mailing Address - Fax:
Practice Address - Street 1:6846 PACIFIC ST
Practice Address - Street 2:SUITE 103
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-1156
Practice Address - Country:US
Practice Address - Phone:402-504-4442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE279863Medicare ID - Type Unspecified