Provider Demographics
NPI:1871839720
Name:MATHEWS FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MATHEWS FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-423-5626
Mailing Address - Street 1:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:BENKELMAN
Mailing Address - State:NE
Mailing Address - Zip Code:69021-0583
Mailing Address - Country:US
Mailing Address - Phone:308-423-5626
Mailing Address - Fax:308-423-5625
Practice Address - Street 1:126 WEST 6TH STREET
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:NE
Practice Address - Zip Code:69033-0404
Practice Address - Country:US
Practice Address - Phone:308-423-5626
Practice Address - Fax:308-423-5625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATHEWS FAMILY CHIROPRACTIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-21
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1237261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NEU79152Medicare UPIN
NE273891Medicare PIN