Provider Demographics
NPI:1639487424
Name:IHLE CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:IHLE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:IHLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-237-3123
Mailing Address - Street 1:3800 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8134
Mailing Address - Country:US
Mailing Address - Phone:308-237-3123
Mailing Address - Fax:308-237-2771
Practice Address - Street 1:3800 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8134
Practice Address - Country:US
Practice Address - Phone:308-237-3123
Practice Address - Fax:308-237-2771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE701305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09567OtherBLUE CROSS BLUE SHIELD
NE09567OtherBLUE CROSS BLUE SHIELD
NE09567OtherBLUE CROSS BLUE SHIELD