Provider Demographics
NPI:1295916484
Name:ROBBI LONG KNUDSEN, DC, LLC
Entity type:Organization
Organization Name:ROBBI LONG KNUDSEN, DC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBBI
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-493-6800
Mailing Address - Street 1:3675 N 129TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-5211
Mailing Address - Country:US
Mailing Address - Phone:402-493-6800
Mailing Address - Fax:402-614-1635
Practice Address - Street 1:3675 N 129TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-5211
Practice Address - Country:US
Practice Address - Phone:402-493-6800
Practice Address - Fax:402-614-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025328800Medicaid
NEU72773Medicare UPIN
NE10025328800Medicaid