Provider Demographics
NPI:1669577946
Name:LINCOLN CHIROPRACTIC CLINIC LLC
Entity type:Organization
Organization Name:LINCOLN CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:LANGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-464-5567
Mailing Address - Street 1:630 N COTNER BLVD
Mailing Address - Street 2:201
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2339
Mailing Address - Country:US
Mailing Address - Phone:402-464-5567
Mailing Address - Fax:402-464-5639
Practice Address - Street 1:630 N COTNER BLVD
Practice Address - Street 2:201
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2339
Practice Address - Country:US
Practice Address - Phone:402-464-5567
Practice Address - Fax:402-464-5639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty