=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245559673
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BILKA CHIROPRACTIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2010
-----------------------------------------------------
Last Update Date | 05/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 4TH AVE. STE. 3
-----------------------------------------------------
City | HOLDREGE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68946-2255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-995-2355
-----------------------------------------------------
Fax | 308-995-2355
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 4TH AVE. STE. 3
-----------------------------------------------------
City | HOLDREGE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68946-2255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-995-2355
-----------------------------------------------------
Fax | 308-995-2355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. LYNDSEY MARIE BILKA
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 308-995-2355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 1518
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------