Provider Demographics
NPI:1215971122
Name:LAUER, DAVID WALTER (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WALTER
Last Name:LAUER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6132 HAVELOCK AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507
Mailing Address - Country:US
Mailing Address - Phone:402-467-5143
Mailing Address - Fax:402-467-5145
Practice Address - Street 1:6132 HAVELOCK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68507
Practice Address - Country:US
Practice Address - Phone:402-467-5143
Practice Address - Fax:402-467-5145
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025110600Medicaid
09675OtherBCBS
T40209Medicare UPIN
NE10025110600Medicaid