Provider Demographics
NPI:1689812539
Name:OURADA CHIROPRACTIC PC
Entity Type:Organization
Organization Name:OURADA CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:OURADA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-759-3892
Mailing Address - Street 1:139 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NE
Mailing Address - Zip Code:68361-2017
Mailing Address - Country:US
Mailing Address - Phone:402-759-3892
Mailing Address - Fax:
Practice Address - Street 1:139 N 9TH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NE
Practice Address - Zip Code:68361-2017
Practice Address - Country:US
Practice Address - Phone:402-759-3892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09536OtherBC/BS
NE=========00Medicaid