Provider Demographics
NPI:1912118985
Name:MADISON CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:MADISON CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-454-2225
Mailing Address - Street 1:222 S MAIN ST
Mailing Address - Street 2:PO BOX 53
Mailing Address - City:MADISON
Mailing Address - State:NE
Mailing Address - Zip Code:68748-6485
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NE
Practice Address - Zip Code:68748-6485
Practice Address - Country:US
Practice Address - Phone:402-454-2225
Practice Address - Fax:402-454-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1588659726OtherINDIVIDUAL NPI
NE100251086-00Medicaid
NEV00509Medicare UPIN
NE1588659726OtherINDIVIDUAL NPI