Healthcare Provider Details

I. General information

NPI: 1639324874
Provider Name (Legal Business Name): MOPAC TRAIL CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N 48TH ST STE 1
LINCOLN NE
68504-3367
US

IV. Provider business mailing address

1184 W PIONEER PKWY
ARLINGTON TX
76013-6367
US

V. Phone/Fax

Practice location:
  • Phone: 402-465-0433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MIKE CAPOBIANCO
Title or Position: OWNER
Credential:
Phone: 402-465-0433