Healthcare Provider Details

I. General information

NPI: 1063979185
Provider Name (Legal Business Name): EXECUTIVE HEALTH SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 S 74TH PLZ
OMAHA NE
68114-4642
US

IV. Provider business mailing address

5003 CROGANS WAY RD
COUNCIL BLUFFS IA
51501-8616
US

V. Phone/Fax

Practice location:
  • Phone: 402-939-8026
  • Fax: 402-249-5497
Mailing address:
  • Phone: 402-320-8770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER C ERICKSON
Title or Position: OWNER
Credential: DPT
Phone: 402-320-8770