Provider Demographics
NPI:1932135688
Name:CREEKWOOD CHIROPRACTIC CLINIC P.C.
Entity Type:Organization
Organization Name:CREEKWOOD CHIROPRACTIC CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-371-0522
Mailing Address - Street 1:110 N 37TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3265
Mailing Address - Country:US
Mailing Address - Phone:402-371-0522
Mailing Address - Fax:402-371-8212
Practice Address - Street 1:110 N 37TH ST
Practice Address - Street 2:STE 405
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3265
Practice Address - Country:US
Practice Address - Phone:402-371-0522
Practice Address - Fax:402-371-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025744100Medicaid
NE10025744100Medicaid