Provider Demographics
NPI:1699854380
Name:MAHONEY, CAROL M (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:M
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68718-0190
Mailing Address - Country:US
Mailing Address - Phone:402-373-2821
Mailing Address - Fax:
Practice Address - Street 1:108 S BROADWAY ST
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMFIELD
Practice Address - State:NE
Practice Address - Zip Code:68718-4400
Practice Address - Country:US
Practice Address - Phone:402-373-2821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09801Medicare UPIN
NE264403MAMedicare ID - Type Unspecified