Provider Demographics
NPI:1922467117
Name:DOCJJR, LLC
Entity Type:Organization
Organization Name:DOCJJR, LLC
Other - Org Name:BACK & BODY WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:JON
Authorized Official - Last Name:RETHWISCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-980-6991
Mailing Address - Street 1:18010 R PLZ STE 104
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-1923
Mailing Address - Country:US
Mailing Address - Phone:402-980-6991
Mailing Address - Fax:
Practice Address - Street 1:11917 PIERCE PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-1648
Practice Address - Country:US
Practice Address - Phone:402-778-1100
Practice Address - Fax:402-778-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty