Provider Demographics
NPI:1790721272
Name:HAVELOCK CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:HAVELOCK CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:LAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-467-5143
Mailing Address - Street 1:6132 HAVELOCK AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507
Mailing Address - Country:US
Mailing Address - Phone:402-467-5143
Mailing Address - Fax:402-467-5145
Practice Address - Street 1:6132 HAVELOCK AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68507
Practice Address - Country:US
Practice Address - Phone:402-467-5143
Practice Address - Fax:402-467-5145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09675OtherBLUE CROSS BLUE SHIELD
27361OtherBLUE CROSS BLUE SHIELD (IDEUS)
NE4114OtherMIDLAND'S CHOICE
NE10025110600Medicaid
NE10025110600Medicaid