Provider Demographics
NPI:1821005620
Name:PLUMMER, KENT C (DC)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:C
Last Name:PLUMMER
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 1:3675 N 129TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-5211
Mailing Address - Country:US
Mailing Address - Phone:402-431-0044
Mailing Address - Fax:402-431-1955
Practice Address - Street 1:3675 N 129TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-5211
Practice Address - Country:US
Practice Address - Phone:402-431-0044
Practice Address - Fax:402-431-1955
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE277853Medicare UPIN
NE099551Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER