=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174665533
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANE D KEPLER D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 07/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4727 N 26TH ST SUITE D
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68521-4706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-438-2090
-----------------------------------------------------
Fax | 402-438-4750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4727 N 26TH ST SUITE D
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68521-4706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-438-2090
-----------------------------------------------------
Fax | 402-438-4750
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1232
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------