Provider Demographics
NPI:1427497205
Name:TILLMAN, MOLLY (DC)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 UNION DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6652
Mailing Address - Country:US
Mailing Address - Phone:402-420-5373
Mailing Address - Fax:
Practice Address - Street 1:3801 UNION DR STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6652
Practice Address - Country:US
Practice Address - Phone:402-420-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026812400Medicaid