Provider Demographics
NPI:1194351569
Name:BELLEVUE CHIROPRACTIC
Entity type:Organization
Organization Name:BELLEVUE CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LUKE
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-905-0132
Mailing Address - Street 1:1311 HARLAN DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-3647
Mailing Address - Country:US
Mailing Address - Phone:402-905-0132
Mailing Address - Fax:
Practice Address - Street 1:1311 HARLAN DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3647
Practice Address - Country:US
Practice Address - Phone:402-905-0132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1497032049OtherINDIVIDUAL NPI
1467719880OtherINDIVIDUAL NPI