Provider Demographics
NPI:1609084367
Name:MCCRACKEN CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:MCCRACKEN CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-421-2277
Mailing Address - Street 1:5740 OLD CHENEY RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3544
Mailing Address - Country:US
Mailing Address - Phone:402-421-2277
Mailing Address - Fax:402-421-7386
Practice Address - Street 1:5740 OLD CHENEY RD
Practice Address - Street 2:SUITE 16
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3544
Practice Address - Country:US
Practice Address - Phone:402-421-2277
Practice Address - Fax:402-421-7386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099412Medicare ID - Type UnspecifiedGROUP NUMBER