Provider Demographics
NPI:1639240351
Name:CHIROPRACTIC HEALTH CLINIC OF MILLARD
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTH CLINIC OF MILLARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:EILER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-778-5470
Mailing Address - Street 1:2727 S 144TH ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5225
Mailing Address - Country:US
Mailing Address - Phone:402-778-5470
Mailing Address - Fax:402-778-5471
Practice Address - Street 1:2727 S 144TH ST
Practice Address - Street 2:SUITE 230
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5225
Practice Address - Country:US
Practice Address - Phone:402-778-5470
Practice Address - Fax:402-778-5471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36654OtherBLUE CROSS BLUE SHIELD
NE125329700OtherFEDERAL WORK COMP PROV #
DN4652OtherRAILROAD MEDICARE
4400188OtherUNITED HEALTHCARE
NE36654OtherBLUE CROSS BLUE SHIELD
4400188OtherUNITED HEALTHCARE
NE900018Medicare PIN
NET40193Medicare UPIN