Provider Demographics
NPI:1194971440
Name:WELL ADJUSTED CHIROPRACTIC PC
Entity type:Organization
Organization Name:WELL ADJUSTED CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:NANCY
Authorized Official - Last Name:JOHNSON ZORTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-204-6012
Mailing Address - Street 1:10835 COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-2677
Mailing Address - Country:US
Mailing Address - Phone:402-934-2299
Mailing Address - Fax:402-934-2277
Practice Address - Street 1:10835 COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-2677
Practice Address - Country:US
Practice Address - Phone:402-934-2299
Practice Address - Fax:402-934-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty