Provider Demographics
NPI:1770767915
Name:SPRING RIDGE CHIROPRACTIC AND ACUPUNCTURE LLC
Entity type:Organization
Organization Name:SPRING RIDGE CHIROPRACTIC AND ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHLOS
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:CROM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-502-6888
Mailing Address - Street 1:17931 PIERCE PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2654
Mailing Address - Country:US
Mailing Address - Phone:402-502-6888
Mailing Address - Fax:402-502-5480
Practice Address - Street 1:17931 PIERCE PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2654
Practice Address - Country:US
Practice Address - Phone:402-502-6888
Practice Address - Fax:402-502-5480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025288300Medicaid
NE279605Medicare UPIN