Provider Demographics
NPI:1861455859
Name:JOHN R. KIRCHNER, MD
Entity Type:Organization
Organization Name:JOHN R. KIRCHNER, MD
Other - Org Name:KIRCHNER HEADACHE CLINIC, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KIRCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-758-2910
Mailing Address - Street 1:13906 GOLD CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2336
Mailing Address - Country:US
Mailing Address - Phone:402-758-2910
Mailing Address - Fax:402-758-2956
Practice Address - Street 1:13906 GOLD CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2336
Practice Address - Country:US
Practice Address - Phone:402-759-2910
Practice Address - Fax:402-758-2956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10745261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025078400Medicaid
IA1904185Medicaid
NE099568Medicare ID - Type Unspecified
NE10025078400Medicaid