Provider Demographics
NPI:1205501665
Name:PROSPINE CHIROPRACTIC
Entity type:Organization
Organization Name:PROSPINE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-401-6065
Mailing Address - Street 1:7216 S 184TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-6504
Mailing Address - Country:US
Mailing Address - Phone:308-660-3605
Mailing Address - Fax:
Practice Address - Street 1:3808 S 203RD PLZ STE 400
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-6403
Practice Address - Country:US
Practice Address - Phone:402-401-6065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty