MEDICARE: COLUMBUS CHIROPRACTIC, INC

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	955	NE

General Provider Information

NPI Number	:	1700053048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	2526 17TH ST
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-4349
Country	:	US
Telephone Number	:	402-562-6776
Fax Number	:

Provider Business Practice Location Address
First Line	:	2526 17TH ST
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-4349
Country	:	US
Telephone Number	:	402-562-6776
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JERRY JIRKA
Credential	:	D.C.
Telephone Number	:	402-562-6776

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	01/16/2013

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Directions to “COLUMBUS CHIROPRACTIC, INC ” Practice Location

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