Provider Demographics
NPI:1841336781
Name:GERINGER, BRENT (DC)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:GERINGER
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 1:216 WEST 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-1812
Mailing Address - Country:US
Mailing Address - Phone:402-443-4164
Mailing Address - Fax:
Practice Address - Street 1:216 WEST 3RD STREET
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-1812
Practice Address - Country:US
Practice Address - Phone:402-443-4164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE11126OtherMIDLANDS
NE09576OtherBCBS
NE47074809213Medicaid
086042Medicare ID - Type Unspecified
NE47074809213Medicaid