=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972194488
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HYDE FAMILY CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2021
-----------------------------------------------------
Last Update Date | 08/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 S 70TH ST STE 107
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68510-7901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-442-0333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 S 70TH ST STE 107
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68510-7901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-442-0333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORGANIZER
-----------------------------------------------------
Name | DR. MACKENZIE HYDE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 402-430-2849
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------