Healthcare Provider Details

I. General information

NPI: 1740592534
Provider Name (Legal Business Name): TRIBA CHIROPRACTIC CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 S 114TH ST
OMAHA NE
68144-4712
US

IV. Provider business mailing address

2720 S 114TH ST
OMAHA NE
68144-4712
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-1652
  • Fax: 402-330-6342
Mailing address:
  • Phone: 402-330-1652
  • Fax: 402-330-6342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number912
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number912
License Number StateNE

VIII. Authorized Official

Name: DR. THOMAS ANDREW TRIBA
Title or Position: OWNER
Credential: D.C.
Phone: 402-330-1652