Provider Demographics
NPI:1922255009
Name:PROGRESSIVE CHIROPRACTIC & REHAB CLINIC, PC
Entity Type:Organization
Organization Name:PROGRESSIVE CHIROPRACTIC & REHAB CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:WHITE
Authorized Official - Last Name:T
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-363-1939
Mailing Address - Street 1:2011 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-1071
Mailing Address - Country:US
Mailing Address - Phone:402-362-2123
Mailing Address - Fax:402-363-2110
Practice Address - Street 1:2011 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-1071
Practice Address - Country:US
Practice Address - Phone:402-362-2123
Practice Address - Fax:402-363-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty