MEDICARE: DR. JERRY ALAN JIRKA 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	955	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22499	OTHER	NE	MIDLAND CHOICE
2	36624	OTHER	NE	BLUE CROSS

General Provider Information

NPI Number	:	1760413140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY ALAN JIRKA D.C.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	01/16/2013

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