Facts
- Status
- A
- Credential
- D.C.
- Type
- Individual
- Enumeration date
- 2012-05-21
- Last updated
- 2022-07-29
Specialties
Licenses
- License NE
- 1716
Location
- Practice location
- 812 COURT ST, STE B
- City
- GIBBON NE
- Postal code
- 688403117
- Phone
- 308-270-1240
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.