Provider Demographics
NPI:1669036810
Name:SUBLUXATION 1, LLC
Entity Type:Organization
Organization Name:SUBLUXATION 1, LLC
Other - Org Name:ACTIVE FAMILY CHIROPRACTIC & ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:P
Authorized Official - Last Name:RIEF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-384-4955
Mailing Address - Street 1:3602 CIMARRON PLZ STE 340
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2895
Mailing Address - Country:US
Mailing Address - Phone:024-249-5500
Mailing Address - Fax:
Practice Address - Street 1:3602 CIMARRON PLZ STE 340
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2895
Practice Address - Country:US
Practice Address - Phone:402-249-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026779101Medicaid