Healthcare Provider Details

I. General information

NPI: 1376851212
Provider Name (Legal Business Name): WAYNE SPORT AND SPINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 N PEARL ST
WAYNE NE
68787-1902
US

IV. Provider business mailing address

214 N PEARL ST
WAYNE NE
68787-1902
US

V. Phone/Fax

Practice location:
  • Phone: 402-375-3000
  • Fax: 402-375-1866
Mailing address:
  • Phone: 402-375-3000
  • Fax: 402-375-1866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number1065
License Number StateNE

VIII. Authorized Official

Name: DR. ROBERT KEVIN KRUGMAN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 402-375-3000