Provider Demographics
NPI:1669584231
Name:PROSOSKI, NICHOLAS A (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:A
Last Name:PROSOSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:PROSOSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:5421 N 103RD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1000
Mailing Address - Country:US
Mailing Address - Phone:402-493-1722
Mailing Address - Fax:402-493-1755
Practice Address - Street 1:5421 N 103RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1000
Practice Address - Country:US
Practice Address - Phone:402-493-1722
Practice Address - Fax:402-493-1755
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100250831Medicaid
NE100250831Medicaid
NE277677Medicare PIN
NEU78735Medicare UPIN