Provider Demographics
NPI:1790765295
Name:LUSE, TIM E (DC)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:E
Last Name:LUSE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3900 DAKOTA AVE
Mailing Address - Street 2:SUITE #6
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-3696
Mailing Address - Country:US
Mailing Address - Phone:402-494-5173
Mailing Address - Fax:402-494-5151
Practice Address - Street 1:3900 DAKOTA AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3696
Practice Address - Country:US
Practice Address - Phone:402-494-5173
Practice Address - Fax:402-494-5151
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47071890200Medicaid
NE47071890200Medicaid