MEDICARE: MAVERICK FAMILY CHIROPRACTIC, LLC

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	1712	NE

General Provider Information

NPI Number	:	1881130482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAVERICK FAMILY CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	8424 W CENTER RD STE 100
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-3138
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8424 W CENTER RD STE 100
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-3138
Country	:	US
Telephone Number	:	402-214-2420
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR/OWNER
Name	:	DR. KILEY ANN SEQUENZIA
Credential	:	DC
Telephone Number	:	402-933-6233

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	03/09/2023

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