Provider Demographics
NPI:1619027380
Name:SUPERIOR CHIROPRACTIC & ACUPUNCTURE PC
Entity Type:Organization
Organization Name:SUPERIOR CHIROPRACTIC & ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WIESE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-434-3033
Mailing Address - Street 1:2500 NORTHVIEW RD
Mailing Address - Street 2:STE 101
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-1228
Mailing Address - Country:US
Mailing Address - Phone:402-438-3033
Mailing Address - Fax:402-438-3034
Practice Address - Street 1:2500 NORTHVIEW RD
Practice Address - Street 2:STE 101
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1228
Practice Address - Country:US
Practice Address - Phone:402-438-3033
Practice Address - Fax:402-438-3034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00387560OtherRAILROAD MEDICARE PART B
NE246252OtherMIDLANDS CHOICE
NE10025326100Medicaid
NE246252OtherMIDLANDS CHOICE
NEP00387560OtherRAILROAD MEDICARE PART B