Provider Demographics
NPI:1427339357
Name:BRENTON THOMAS & ASSOCIATES LLC
Entity type:Organization
Organization Name:BRENTON THOMAS & ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-905-2571
Mailing Address - Street 1:625 N 114TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1514
Mailing Address - Country:US
Mailing Address - Phone:402-905-2571
Mailing Address - Fax:402-682-7503
Practice Address - Street 1:5421 N 103RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1000
Practice Address - Country:US
Practice Address - Phone:402-350-4030
Practice Address - Fax:402-493-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099151003OtherMEDICARE PTAN
NE50813318700Medicaid