Provider Demographics
NPI:1134274806
Name:COMMUNITY CHIROPRACTIC CLINICS PC
Entity type:Organization
Organization Name:COMMUNITY CHIROPRACTIC CLINICS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-269-3130
Mailing Address - Street 1:112 PARK ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NE
Mailing Address - Zip Code:68446-9609
Mailing Address - Country:US
Mailing Address - Phone:402-269-3130
Mailing Address - Fax:
Practice Address - Street 1:112 PARK ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NE
Practice Address - Zip Code:68446-9609
Practice Address - Country:US
Practice Address - Phone:402-269-3130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099010SYMedicare ID - Type UnspecifiedGROUP MEDICARE
NE=========01Medicare ID - Type UnspecifiedGROUP MEDICAID