Healthcare Provider Details

I. General information

NPI: 1306842638
Provider Name (Legal Business Name): BEN ROBERT BUETTENBACK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5533 NW 1ST ST STE 102
LINCOLN NE
68521-4474
US

IV. Provider business mailing address

5533 NW 1ST ST STE 102
LINCOLN NE
68521-4474
US

V. Phone/Fax

Practice location:
  • Phone: 402-476-8483
  • Fax: 402-742-3783
Mailing address:
  • Phone: 402-476-8483
  • Fax: 402-742-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1347
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: