Provider Demographics
NPI:1972805521
Name:RYAN L. VILLWOK, D.C, P.C.
Entity Type:Organization
Organization Name:RYAN L. VILLWOK, D.C, P.C.
Other - Org Name:NELSON CHIROPRACTIC & ACTIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:VILLWOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-720-5642
Mailing Address - Street 1:12313 GOLD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2760
Mailing Address - Country:US
Mailing Address - Phone:402-334-1200
Mailing Address - Fax:
Practice Address - Street 1:12313 GOLD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2760
Practice Address - Country:US
Practice Address - Phone:402-334-1200
Practice Address - Fax:402-334-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1638111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty