Provider Demographics
NPI:1740592534
Name:TRIBA CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:TRIBA CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:TRIBA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-330-1652
Mailing Address - Street 1:2720 S 114TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4712
Mailing Address - Country:US
Mailing Address - Phone:402-330-1652
Mailing Address - Fax:402-330-6342
Practice Address - Street 1:2720 S 114TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4712
Practice Address - Country:US
Practice Address - Phone:402-330-1652
Practice Address - Fax:402-330-6342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE912302F00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1396815676OtherNPI