Provider Demographics
NPI:1669523577
Name:SOUTHWEST CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:SOUTHWEST CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-421-8284
Mailing Address - Street 1:1501 PINE LAKE RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-3692
Mailing Address - Country:US
Mailing Address - Phone:402-421-8284
Mailing Address - Fax:402-421-8220
Practice Address - Street 1:1501 PINE LAKE RD
Practice Address - Street 2:SUITE #2
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-3692
Practice Address - Country:US
Practice Address - Phone:402-421-8284
Practice Address - Fax:402-421-8220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1203111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100251735-00Medicaid
NEU77577Medicare UPIN
NE100251735-00Medicaid