Provider Demographics
NPI:1902410541
Name:ESHELMAN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ESHELMAN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESHELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-543-8143
Mailing Address - Street 1:6720 S 168TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3168
Mailing Address - Country:US
Mailing Address - Phone:531-999-1031
Mailing Address - Fax:
Practice Address - Street 1:6720 S 168TH ST STE 3
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3168
Practice Address - Country:US
Practice Address - Phone:531-999-1031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty