Provider Demographics
NPI:1962460162
Name:MILLIGAN, JERRY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:LEE
Last Name:MILLIGAN
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 1:42651 ROAD 751
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:NE
Mailing Address - Zip Code:68937-2806
Mailing Address - Country:US
Mailing Address - Phone:308-440-9947
Mailing Address - Fax:308-698-0528
Practice Address - Street 1:317 W 11TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-7331
Practice Address - Country:US
Practice Address - Phone:308-698-0525
Practice Address - Fax:308-698-0528
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE278842Medicare ID - Type Unspecified
NEV05588Medicare UPIN