=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861401275
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPLEWOOD CHIROPRACTIC CLINIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 10/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4611 S 96TH ST STE 156
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68127-1242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-331-9444
-----------------------------------------------------
Fax | 402-331-4142
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4611 S 96TH ST STE 156
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68127-1242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-331-9444
-----------------------------------------------------
Fax | 402-331-4142
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JEREMY JOSEPH HAPP
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 402-331-9444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1421
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------