Provider Demographics
NPI:1891916524
Name:ONEAL CHIROPRACTIC CLINIC,P.C.
Entity Type:Organization
Organization Name:ONEAL CHIROPRACTIC CLINIC,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ONEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-632-8779
Mailing Address - Street 1:302 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4633
Mailing Address - Country:US
Mailing Address - Phone:308-632-8779
Mailing Address - Fax:308-632-7688
Practice Address - Street 1:302 W 40TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4633
Practice Address - Country:US
Practice Address - Phone:308-632-8779
Practice Address - Fax:308-632-7688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE=========13Medicaid
NET40199Medicare UPIN