Provider Demographics
NPI:1619157674
Name:MIDWEST CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:MIDWEST CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALESA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-379-4870
Mailing Address - Street 1:407 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4724
Mailing Address - Country:US
Mailing Address - Phone:402-379-4870
Mailing Address - Fax:402-379-0204
Practice Address - Street 1:407 S 17TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4724
Practice Address - Country:US
Practice Address - Phone:402-379-4870
Practice Address - Fax:402-379-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09815OtherBLUE CROSS BLUE SHIELD
NE=========00Medicaid
NE099679Medicare PIN
NE=========00Medicaid