Healthcare Provider Details

I. General information

NPI: 1205501665
Provider Name (Legal Business Name): PROSPINE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 S 203RD PLZ STE 400
OMAHA NE
68130-6403
US

IV. Provider business mailing address

7216 S 184TH ST
OMAHA NE
68136-6504
US

V. Phone/Fax

Practice location:
  • Phone: 402-401-6065
  • Fax:
Mailing address:
  • Phone: 308-660-3605
  • 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. ALISHA LYNN FLETCHER
Title or Position: OWNER/DOCTOR
Credential: DC
Phone: 402-401-6065