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General NPI Number Information
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NPI Number | 1265673503
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Entity Type | Organization
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Legal Business Name | PAPILLION CHIROPRACTIC, P.C.
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 05/15/2009
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Provider Practice Location Address
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Address Line | 741 PINNACLE DRIVE
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City | PAPILLION
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State | NE
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Zip | 68046-0015
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Country | US
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Telephone | 402-932-8384
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Fax |
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Provider Business Mailing Address
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Address Line | 741 PINNACLE DRIVE
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City | PAPILLION
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State | NE
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Zip | 68046-0015
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Country | US
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Telephone | 402-932-8384
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Fax |
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DR. TONYA L BOECKENHAUER
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Credential | D.C.
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Telephone | 402-932-8384
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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 | 1536
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License Number State | NE
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