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General NPI Number Information
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NPI Number | 1518156587
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Entity Type | Organization
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Legal Business Name | TRIUMPH 80 PC
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 115 E SHERMAN ST
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City | WEST POINT
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State | NE
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Zip | 68788-2229
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Country | US
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Telephone | 402-372-9900
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Fax | 402-372-9909
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Provider Business Mailing Address
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Address Line | 803 PROVIDENCE RD STE 101
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City | WAYNE
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State | NE
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Zip | 68787-1590
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Country | US
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Telephone | 402-375-3450
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Fax | 402-375-3450
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOELLE NAOMI HERMAN
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Credential | D.C.
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Telephone | 402-375-3450
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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 | 1303
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License Number State | NE
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