Provider Demographics
NPI:1700837390
Name:MCCRACKEN, GEORGE R (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:R
Last Name:MCCRACKEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 OLD CHENEY RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3544
Mailing Address - Country:US
Mailing Address - Phone:402-421-2277
Mailing Address - Fax:402-421-7386
Practice Address - Street 1:5740 OLD CHENEY RD
Practice Address - Street 2:SUITE 16
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3544
Practice Address - Country:US
Practice Address - Phone:402-421-2277
Practice Address - Fax:402-421-7386
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE16180OtherMIDLAND'S CHOICE
NEP0005754324KOtherRAILROAD MEDICARE PIN
NE100250128-00Medicaid
NE99676OtherBLUE CROSS BLUE SHIELD
NE276938Medicare ID - Type Unspecified