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General NPI Number Information
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NPI Number | 1194914945
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Entity Type | Organization
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Legal Business Name | AVENUE CHIROPRACTIC & WELLNESS CLINIC, PC
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 2559 37TH AVE
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City | COLUMBUS
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State | NE
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Zip | 68601-2359
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Country | US
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Telephone | 402-564-7514
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Fax | 402-564-3439
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Provider Business Mailing Address
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Address Line | PO BOX 673
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City | COLUMBUS
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State | NE
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Zip | 68602-0673
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Country | US
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Telephone | 402-564-7514
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Fax | 402-564-3439
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Authorized Official
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Title or Position | OWNER
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Name | DR. RALPH B CRABTREE
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Credential | D.C.
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Telephone | 402-564-7514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 952
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License Number State | NE
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