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General NPI Number Information
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NPI Number | 1669577946
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Entity Type | Organization
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Legal Business Name | LINCOLN CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 630 N COTNER BLVD 201
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City | LINCOLN
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State | NE
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Zip | 68505-2339
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Country | US
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Telephone | 402-464-5567
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Fax | 402-464-5639
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Provider Business Mailing Address
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Address Line | 630 N COTNER BLVD 201
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City | LINCOLN
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State | NE
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Zip | 68505-2339
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Country | US
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Telephone | 402-464-5567
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Fax | 402-464-5639
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Authorized Official
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Title or Position | CHIROPRACTOR/SOLE MEMBER
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Name | DR. PERRY VINCENT LANGSTON
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Credential | D.C.
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Telephone | 402-464-5567
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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 | 1202
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License Number State | NE
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