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General NPI Number Information
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NPI Number | 1679662191
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Entity Type | Organization
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Legal Business Name | CLOCKTOWER CHIROPRACTIC, INC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 633 N 98TH ST
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City | OMAHA
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State | NE
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Zip | 68114-2342
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Country | US
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Telephone | 402-397-8980
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Fax | 402-397-8977
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Provider Business Mailing Address
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Address Line | 633 N 98TH ST
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City | OMAHA
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State | NE
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Zip | 68114-2342
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Country | US
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Telephone | 402-397-8980
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Fax | 402-397-8977
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RYAN P GOSS
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Credential | D.C.
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Telephone | 402-397-8980
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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 | 1404
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License Number State | NE
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