Provider Demographics
NPI:1689922288
Name:ORD SPORTS CHIROPRACTIC AND WELLNESS, LLC
Entity Type:Organization
Organization Name:ORD SPORTS CHIROPRACTIC AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:J
Authorized Official - Last Name:STAAB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-728-9986
Mailing Address - Street 1:232 SOUTH 16TH STREET
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862
Mailing Address - Country:US
Mailing Address - Phone:308-728-9986
Mailing Address - Fax:308-728-9987
Practice Address - Street 1:232 SOUTH 16TH STREET
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862
Practice Address - Country:US
Practice Address - Phone:308-728-9986
Practice Address - Fax:308-728-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1720111N00000X
NE3678225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty