MEDICARE: MIDWEST INTEGRATIVE HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center		NE

General Provider Information

NPI Number	:	1760921472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST INTEGRATIVE HEALTH

Provider Business Mailing Address
First Line	:	4611 S 96TH ST
Second Line	:	SUITE 139
City	:	OMAHA
State	:	NE
Zip	:	68127-1202
Country	:	US
Telephone Number	:	402-281-0825
Fax Number	:	402-281-0852

Provider Business Practice Location Address
First Line	:	4611 S 96TH ST
Second Line	:	SUITE 139
City	:	OMAHA
State	:	NE
Zip	:	68127-1202
Country	:	US
Telephone Number	:	402-281-0825
Fax Number	:	402-281-0852

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. JACEY THOMAS FOLKERS
Credential	:	D.C.
Telephone Number	:	402-281-0825

Provider Enumeration Date	:	02/14/2017
Last Update Date	:	02/14/2017

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