Healthcare Provider Details

I. General information

NPI: 1518156587
Provider Name (Legal Business Name): TRIUMPH 80 PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E SHERMAN ST
WEST POINT NE
68788-2229
US

IV. Provider business mailing address

803 PROVIDENCE RD STE 101
WAYNE NE
68787-1590
US

V. Phone/Fax

Practice location:
  • Phone: 402-372-9900
  • Fax: 402-372-9909
Mailing address:
  • Phone: 402-375-3450
  • Fax: 402-375-3450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1303
License Number StateNE

VIII. Authorized Official

Name: DR. JOELLE NAOMI HERMAN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 402-375-3450