Provider Demographics
NPI:1629088380
Name:CLEMENTS, ERIC MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:MICHAEL
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 N 156TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-6465
Mailing Address - Country:US
Mailing Address - Phone:402-493-6777
Mailing Address - Fax:402-493-7909
Practice Address - Street 1:2055 N 156TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-6465
Practice Address - Country:US
Practice Address - Phone:402-493-6777
Practice Address - Fax:402-493-7909
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE24781923400Medicaid
NE9824OtherBLUE CROSS BLUE SHIELD
NE9824OtherBLUE CROSS BLUE SHIELD
NE272262Medicare ID - Type Unspecified