Healthcare Provider Details

I. General information

NPI: 1104109321
Provider Name (Legal Business Name): MYPAINDOC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4307 23RD ST
COLUMBUS NE
68601-8507
US

IV. Provider business mailing address

4307 23RD ST
COLUMBUS NE
68601-8507
US

V. Phone/Fax

Practice location:
  • Phone: 402-563-2978
  • Fax: 402-563-2976
Mailing address:
  • Phone: 402-563-2978
  • Fax: 402-563-2976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number23401
License Number StateNE

VIII. Authorized Official

Name: DR. DANIEL M WIK
Title or Position: DOCTOR
Credential: MD
Phone: 402-563-2978