Provider Demographics
NPI:1720337421
Name:SOUTHSIDE CHIROPRACTIC
Entity Type:Organization
Organization Name:SOUTHSIDE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPARTMENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-505-3088
Mailing Address - Street 1:4938 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-2705
Mailing Address - Country:US
Mailing Address - Phone:402-505-3088
Mailing Address - Fax:402-505-3549
Practice Address - Street 1:4938 S 24TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-2705
Practice Address - Country:US
Practice Address - Phone:402-505-3088
Practice Address - Fax:402-505-3549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty