Provider Demographics
NPI:1962654590
Name:NENEMAN, NICHOLAS MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:MICHAEL
Last Name:NENEMAN
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 1:1808 N 120TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1392
Mailing Address - Country:US
Mailing Address - Phone:402-496-0147
Mailing Address - Fax:402-496-4222
Practice Address - Street 1:1808 N 120TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1392
Practice Address - Country:US
Practice Address - Phone:402-496-0147
Practice Address - Fax:402-496-4222
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025725700Medicaid
NENA1198001Medicare PIN