NPIMap

Organization Active NPI

Tri-State Physicians & Physical Therapy Clinic PC

  • Chiropractor
  • South Sioux City, NE
National Provider Identifier
1114180767
Registry record updated Jul 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
753 Issued in NE
Legal business name
TRI-STATE PHYSICIANS & PHYSICAL THERAPY CLINIC PC
Practice address
3900 Dakota Ave Ste 6
South Sioux City, NE 68776-3696
Phone
(402) 494-5173
Fax
(402) 494-5151
NPI assigned
Jul 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tim E Luse, D.C.NPI 1790765295
Title
Medical Administrator
Phone
(402) 494-5173

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 684 NE
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 753 NE Primary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 1289 NE
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 82 NE

Addresses

Primary practice location

3900 Dakota Ave Ste 6
South Sioux City, NE 68776-3696

Mailing address

3900 Dakota Ave Ste 6
South Sioux City, NE 68776-3696
Phone (402) 494-5173

Other names 1

  • TRI-STATE CHIROPRACTIC CLINIC INC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090128000266 NE Part B Supplier - Clinic/Group Practice 1951465442 Receives reassigned benefits from 9 practitioners
Practice locations: South Sioux City, NE
O20170918002640 NE DME Supplier - Nurse PractitionerDME Supplier - Physician - ChiropracticDME Supplier - Physician - Physical and Rehabilitation 1951465442 Practice locations: South Sioux City, NE

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
28D0455674Tri-State Physicians & Physical Therapy Clinic PC3900 Dakota Avenue Suite #6, South Sioux City, NE 68776Certificate of waiverAug 31, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Tri-State Physicians & Physical the3900 Dakota Ave, South Sioux City, NE 68776-3696(402) 494-5173 Heat & Cold Applications|Traction Equipment|(TENS) Transcutaneous Electrical Nerve Stimulators and/or Supplies|Canes and/or Crutches|Walkers|Wheelchairs (Standard Manual)|Wheelchair Seating/Cushions|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf Accepts assignmentParticipating since Jan 1, 2009

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215043200000",
    "number": "1114180767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 DAKOTA AVE STE 6",
            "city": "SOUTH SIOUX CITY",
            "state": "NE",
            "postal_code": "687763696",
            "telephone_number": "402-494-5173",
            "fax_number": "402-494-5151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 DAKOTA AVE STE 6",
            "city": "SOUTH SIOUX CITY",
            "state": "NE",
            "postal_code": "687763696",
            "telephone_number": "402-494-5173",
            "fax_number": "402-494-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE PHYSICIANS & PHYSICAL THERAPY CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-03",
        "last_updated": "2008-07-03",
        "status": "A",
        "authorized_official_last_name": "LUSE",
        "authorized_official_first_name": "TIM",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MEDICAL ADMINISTRATOR",
        "authorized_official_telephone_number": "402-494-5173",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "NE",
            "license": "684",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "NE",
            "license": "753",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "NE",
            "license": "1289",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NE",
            "license": "82",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TRI-STATE CHIROPRACTIC CLINIC INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in South Sioux City, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.