Provider Demographics
NPI:1154923126
Name:SUBLUXATION 2 LLC
Entity type:Organization
Organization Name:SUBLUXATION 2 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RIEF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-384-4955
Mailing Address - Street 1:2441 N DIERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1240
Mailing Address - Country:US
Mailing Address - Phone:308-384-4955
Mailing Address - Fax:308-384-7088
Practice Address - Street 1:5012 3RD AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-8506
Practice Address - Country:US
Practice Address - Phone:308-222-4400
Practice Address - Fax:308-222-4038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026848500Medicaid