Provider Demographics
NPI:1669650982
Name:MEREDITH, LAURA J (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:J
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:J
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2111 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1245
Mailing Address - Country:US
Mailing Address - Phone:402-345-7500
Mailing Address - Fax:402-345-5228
Practice Address - Street 1:2111 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1245
Practice Address - Country:US
Practice Address - Phone:402-345-7500
Practice Address - Fax:402-345-5228
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0973727Medicaid
NE09798OtherBCBS OF NE
NEP00659532OtherRR MEDICARE
NE255961OtherMIDLANDS CHOICE
NE$$$$$$$$$Medicaid
NE091598001Medicare PIN