Healthcare Provider Details

I. General information

NPI: 1376565655
Provider Name (Legal Business Name): JEFFREY SCOTT GROENE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 16TH ST
SCHUYLER NE
68661-1348
US

IV. Provider business mailing address

410 W 16TH ST
SCHUYLER NE
68661-1348
US

V. Phone/Fax

Practice location:
  • Phone: 402-352-3399
  • Fax: 402-352-3099
Mailing address:
  • Phone: 402-352-3399
  • Fax: 402-352-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5619
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: