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General NPI Number Information
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NPI Number | 1417753526
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Entity Type | Organization
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Legal Business Name | VICTORY CHIROPRACTIC AND WELLNESS LLC
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 820 S 75TH ST
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City | OMAHA
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State | NE
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Zip | 68114-4623
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Country | US
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Telephone | 402-391-2477
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Fax | 402-397-4268
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Provider Business Mailing Address
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Address Line | 820 S 75TH ST
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City | OMAHA
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State | NE
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Zip | 68114-4623
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Country | US
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Telephone | 402-391-2477
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Fax | 402-397-4268
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | MOLLY MATTHES
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Credential | DC
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Telephone | 402-391-2477
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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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