Provider Demographics
NPI:1316109135
Name:VAN ENGEN CHIROPRACTIC CLINIC PC
Entity type:Organization
Organization Name:VAN ENGEN CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:VAN ENGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-486-3858
Mailing Address - Street 1:7441 O ST. SUITE 200
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510
Mailing Address - Country:US
Mailing Address - Phone:402-486-3858
Mailing Address - Fax:402-486-3859
Practice Address - Street 1:7441 O ST. SUITE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510
Practice Address - Country:US
Practice Address - Phone:402-486-3858
Practice Address - Fax:402-486-3859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE9709OtherBLUE CROSS BLUE SHIELD
NE9709OtherBLUE CROSS BLUE SHIELD