Provider Demographics
NPI:1942394960
Name:DOWNTOWN CHIROPRACTIC HEALTH CENTER PC
Entity Type:Organization
Organization Name:DOWNTOWN CHIROPRACTIC HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGAER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-345-7500
Mailing Address - Street 1:2111 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1245
Mailing Address - Country:US
Mailing Address - Phone:402-345-7500
Mailing Address - Fax:402-345-5522
Practice Address - Street 1:2111 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1245
Practice Address - Country:US
Practice Address - Phone:402-345-7500
Practice Address - Fax:402-345-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0973727Medicaid
NE350019040OtherRR MEDICARE
NE091598Medicare ID - Type Unspecified
NE=========-13Medicare ID - Type Unspecified