Healthcare Provider Details

I. General information

NPI: 1366638603
Provider Name (Legal Business Name): BRYAN THOMAS VOITHOFER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506 BURT CIR
OMAHA NE
68114-2094
US

IV. Provider business mailing address

10506 BURT CIR
OMAHA NE
68114-2094
US

V. Phone/Fax

Practice location:
  • Phone: 402-676-9544
  • Fax:
Mailing address:
  • Phone: 402-676-9544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5075
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number1742
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: