Provider Demographics
NPI:1821548405
Name:COMPLETE CHIROPRACTIC & LASER LLC
Entity Type:Organization
Organization Name:COMPLETE CHIROPRACTIC & LASER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:S
Authorized Official - Last Name:QUALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-376-8055
Mailing Address - Street 1:313 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VALENTINE
Mailing Address - State:NE
Mailing Address - Zip Code:69201-1841
Mailing Address - Country:US
Mailing Address - Phone:402-376-8055
Mailing Address - Fax:402-376-8075
Practice Address - Street 1:313 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VALENTINE
Practice Address - State:NE
Practice Address - Zip Code:69201-1841
Practice Address - Country:US
Practice Address - Phone:402-376-8055
Practice Address - Fax:402-376-8075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty