Provider Demographics
NPI:1609170729
Name:COREY ANDERSON DC INC
Entity Type:Organization
Organization Name:COREY ANDERSON DC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC,
Authorized Official - Phone:402-462-9999
Mailing Address - Street 1:223 E 14TH ST
Mailing Address - Street 2:SUITE 50
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3200
Mailing Address - Country:US
Mailing Address - Phone:402-462-9999
Mailing Address - Fax:402-462-9545
Practice Address - Street 1:223 E 14TH ST
Practice Address - Street 2:SUITE 50
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3200
Practice Address - Country:US
Practice Address - Phone:402-462-9999
Practice Address - Fax:402-462-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47084081600Medicaid
NE99559OtherBLUE CROSS BLUE SHIELD
NE268514OtherCOVENTRY
NE350055386OtherRAIL ROAD MEDICARE
NE268514OtherCOVENTRY