Provider Demographics
NPI:1760413140
Name:JIRKA, JERRY ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ALAN
Last Name:JIRKA
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 1:2526 17TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-4349
Mailing Address - Country:US
Mailing Address - Phone:402-562-6776
Mailing Address - Fax:
Practice Address - Street 1:2526 17TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-4349
Practice Address - Country:US
Practice Address - Phone:402-562-6776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE22499OtherMIDLAND CHOICE
NE36624OtherBLUE CROSS
NET-89783Medicare UPIN
NE36624OtherBLUE CROSS