Provider Demographics
NPI:1659440139
Name:EILER, MARK BRIAN (DC PC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BRIAN
Last Name:EILER
Suffix:
Gender:M
Credentials:DC PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
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:68144-5227
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:68144-5227
Practice Address - Country:US
Practice Address - Phone:402-778-5470
Practice Address - Fax:402-778-5471
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE91179178100Medicaid
NE350050349OtherRAILROAD MEDICARE
NE36654OtherBLUE CROSS BLUE SHIELD
NE272624Medicare ID - Type Unspecified
NE91179178100Medicaid