Provider Demographics
NPI:1891376919
Name:PROVISION CHIROPRACTIC AND WELLNESS, LLC
Entity Type:Organization
Organization Name:PROVISION CHIROPRACTIC AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOCHSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-369-1080
Mailing Address - Street 1:2755 JAMIE LN STE 9
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-7750
Mailing Address - Country:US
Mailing Address - Phone:531-500-2412
Mailing Address - Fax:531-500-4520
Practice Address - Street 1:2755 JAMIE LN STE 9
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-7750
Practice Address - Country:US
Practice Address - Phone:531-500-2412
Practice Address - Fax:531-500-4520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty