Healthcare Provider Details

I. General information

NPI: 1205635786
Provider Name (Legal Business Name): BLAKE W CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 04/14/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 PIONEER WOODS DR STE 3
LINCOLN NE
68506-7552
US

IV. Provider business mailing address

4130 PIONEER WOODS DR STE 3
LINCOLN NE
68506-7552
US

V. Phone/Fax

Practice location:
  • Phone: 402-261-6841
  • Fax:
Mailing address:
  • Phone: 402-261-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. BLAKE TYLER WILLS
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 308-641-7120