MEDICARE: DAVID JOHN EISENMENGER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1667	NE

General Provider Information

NPI Number	:	1508158064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID JOHN EISENMENGER D.C.

Provider Business Mailing Address
First Line	:	15615 PACIFIC ST
Second Line	:	STE 6
City	:	OMAHA
State	:	NE
Zip	:	68118-2118
Country	:	US
Telephone Number	:	913-575-2410
Fax Number	:

Provider Business Practice Location Address
First Line	:	11720 BLUE RIDGE BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64134-3718
Country	:	US
Telephone Number	:	913-575-2410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	03/29/2017

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