Provider Demographics
NPI:1962505131
Name:LINCOLN GATEWAY CHIROPRACTIC
Entity Type:Organization
Organization Name:LINCOLN GATEWAY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:WAWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-464-5567
Mailing Address - Street 1:3830 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-1934
Mailing Address - Country:US
Mailing Address - Phone:402-464-5567
Mailing Address - Fax:402-464-5639
Practice Address - Street 1:3830 ADAMS ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-1934
Practice Address - Country:US
Practice Address - Phone:402-464-5567
Practice Address - Fax:402-464-5639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025151000Medicaid