Provider Demographics
NPI:1992772420
Name:J F D C INC
Entity type:Organization
Organization Name:J F D C INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-884-5599
Mailing Address - Street 1:4979 S 155TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-5007
Mailing Address - Country:US
Mailing Address - Phone:402-884-5599
Mailing Address - Fax:402-884-7975
Practice Address - Street 1:4979 S 155TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137
Practice Address - Country:US
Practice Address - Phone:402-884-5599
Practice Address - Fax:402-884-7975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025042000Medicaid
NE7272476OtherAETNA
NED09553OtherBCBS
NE240442OtherMIDLANDS CHOICE
NE240442OtherMIDLANDS CHOICE
NE099411Medicare ID - Type Unspecified
NE10025042000Medicaid