Basic Information
| Provider Information | |||||||||
| NPI: | 1265673503 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PAPILLION CHIROPRACTIC, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 741 PINNACLE DRIVE | ||||||||
| Address2: | |||||||||
| City: | PAPILLION | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680460015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029328384 | ||||||||
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| Practice Location | |||||||||
| Address1: | 741 PINNACLE DRIVE | ||||||||
| Address2: | |||||||||
| City: | PAPILLION | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680460015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029328384 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2009 | ||||||||
| LastUpdateDate: | 05/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | BOECKENHAUER | ||||||||
| AuthorizedOfficialFirstName: | TONYA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4029328384 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 1536 | NE | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.