Provider Demographics
NPI:1851507578
Name:ELKHORN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ELKHORN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-359-1422
Mailing Address - Street 1:20214 VETERANS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-6900
Mailing Address - Country:US
Mailing Address - Phone:402-359-1422
Mailing Address - Fax:402-359-1424
Practice Address - Street 1:20214 VETERANS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-6900
Practice Address - Country:US
Practice Address - Phone:402-359-1422
Practice Address - Fax:402-359-1424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134120785OtherINDIVIDUAL NPI
NE246973OtherMIDLANDS CHOICE
NE09803OtherBCBS
NE100253167-00Medicaid
NE264433OtherCOVENTRY
NE09803OtherBCBS
NE099794Medicare ID - Type UnspecifiedGROUP PROVIDER
NE100253167-00Medicaid