Healthcare Provider Details
I. General information
NPI: 1124512298
Provider Name (Legal Business Name): AKRIDGE AND AKRIDGE CHIROPRACTIC WEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/21/2018
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1529 S 203RD ST STE 103
OMAHA NE
68130-2867
US
IV. Provider business mailing address
1529 S 203RD ST STE 103
OMAHA NE
68130-2867
US
V. Phone/Fax
- Phone: 402-884-4774
- Fax:
- Phone: 402-884-4774
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 111N00000X |
| Taxonomy | Chiropractor |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
CRAIG
A
AKRIDGE
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 402-253-9350