Basic Information
| Provider Information | |||||||||
| NPI: | 1841645694 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VACEK | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6901 N 72ND ST STE 22905 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681221709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025722340 | ||||||||
| FaxNumber: | 4025722632 | ||||||||
| Practice Location | |||||||||
| Address1: | 6901 N 72ND ST STE 22905 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681221709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025722340 | ||||||||
| FaxNumber: | 4025722632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2016 | ||||||||
| LastUpdateDate: | 08/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | S2527 | TX | N | Allopathic & Osteopathic Physicians | General Practice | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208100000X | 32610 | NE | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.