Provider Demographics
NPI:1194914945
Name:AVENUE CHIROPRACTIC & WELLNESS CLINIC, PC
Entity type:Organization
Organization Name:AVENUE CHIROPRACTIC & WELLNESS CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-564-7514
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68602-0673
Mailing Address - Country:US
Mailing Address - Phone:402-564-7514
Mailing Address - Fax:402-564-3439
Practice Address - Street 1:2559 37TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2359
Practice Address - Country:US
Practice Address - Phone:402-564-7514
Practice Address - Fax:402-564-3439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE091587Medicare PIN
C01655Medicare PIN