Healthcare Provider Details

I. General information

NPI: 1730904236
Provider Name (Legal Business Name): KEALEY JUELS NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16831 LAKESIDE HILLS PLZ
OMAHA NE
68130-2322
US

IV. Provider business mailing address

16830 LAKESIDE HILLS PLZ
OMAHA NE
68130
US

V. Phone/Fax

Practice location:
  • Phone: 402-934-7557
  • Fax:
Mailing address:
  • Phone: 402-934-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2202
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: