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General NPI Number Information
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NPI Number | 1356157192
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Entity Type | Organization
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Legal Business Name | GOLDEN KOALA GROUP, LLC
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 10815 PRAIRIE BROOK RD
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City | OMAHA
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State | NE
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Zip | 68144-4827
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Country | US
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Telephone | 402-397-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 10815 PRAIRIE BROOK RD
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City | OMAHA
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State | NE
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Zip | 68144-4827
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Country | US
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Telephone | 757-434-0214
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | CHRISTINE ROLLMAN
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Credential | DC
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Telephone | 402-397-1800
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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 |
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License Number State |
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