Provider Demographics
NPI:1902843295
Name:BARTHOLET, JOHN ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERIC
Last Name:BARTHOLET
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12308 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-4219
Mailing Address - Country:US
Mailing Address - Phone:402-452-3275
Mailing Address - Fax:
Practice Address - Street 1:108 N 49TH ST
Practice Address - Street 2:206
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-3147
Practice Address - Country:US
Practice Address - Phone:402-341-2216
Practice Address - Fax:402-553-7071
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE13421024100Medicaid
NE13421024100Medicaid