Healthcare Provider Details

I. General information

NPI: 1124228192
Provider Name (Legal Business Name): STINNETTE CHIROPRACTIC CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 E 23RD AVE S SUITE A
FREMONT NE
68025-7849
US

IV. Provider business mailing address

2155 E 23RD AVE S SUITE A
FREMONT NE
68025-7849
US

V. Phone/Fax

Practice location:
  • Phone: 402-721-0336
  • Fax: 402-721-8672
Mailing address:
  • Phone: 402-721-0336
  • Fax: 402-721-8672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1364
License Number StateNE

VIII. Authorized Official

Name: SCOTT RYAN STINNETTE
Title or Position: PRESIDENT/OWNER
Credential: D.C.
Phone: 402-721-0336