Provider Demographics
NPI:1457542193
Name:CANDLEWOOD CHIROPRACTIC CLINIC P C
Entity Type:Organization
Organization Name:CANDLEWOOD CHIROPRACTIC CLINIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEPINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-496-0147
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE882261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4400633OtherAMERICHOICE
NE0005995064OtherAETNA
NE86489OtherCOVENTRY HEALTHCARE OF NE
NE=========-00Medicaid
NE4400633OtherAMERICHOICE
NE=========OtherBLUE CROSS OF NE
NE========= 0001OtherCIGNA HEATHCARE
NE=========-00Medicaid