Provider Demographics
NPI:1437295581
Name:DENAEYER CHIROPRACTIC
Entity type:Organization
Organization Name:DENAEYER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DENAEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-532-0234
Mailing Address - Street 1:308 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-3828
Mailing Address - Country:US
Mailing Address - Phone:308-532-0234
Mailing Address - Fax:308-532-0370
Practice Address - Street 1:308 W 4TH ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-3828
Practice Address - Country:US
Practice Address - Phone:308-532-0234
Practice Address - Fax:308-532-0370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09530OtherBLUE CROSS BLUE SHIELD
NEP00304269OtherR R MEDICARE
NE100252297-00Medicaid
NE09530OtherBLUE CROSS BLUE SHIELD
NE100252297-00Medicaid