Thomas Matthew Etter, DC
Individual provider Active NPI Chiropractor · Ponca, NE
NPI 1477572345 · NPPES record last updated Aug 15, 2014
Key facts
- NPI
- 1477572345
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 1185 (NE)
- Practice address
- 111 N Union St # 107
Ponca, NE 68770-7297 - Phone
- (402) 755-4111
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 1997
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
111 N Union St
Suite 107
Ponca, NE 68770-7297
Phone (402) 755-4111
111 Union
Suite 107
Ponca, NE 68770-7297
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140917001273 | NE | Practitioner - Chiropractic | 4486752680 | Practice locations: Ponca, NE |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1185 | NE | MD | Mental Health Counselor |
| 4640 | KS | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Decker Chiropractic Walk-in-Care, PA | Chiropractor | Past |
Accepting new patients |
| Chiropractic Associates, P.C. , Inc. | Chiropractor | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 4640 | KS | |
| Chiropractor | 111N00000X | 1185 | NE | Yes |
Addresses
Primary practice location
111 N Union St # 107
Ponca, NE 68770-7297
Mailing address
PO Box 107
Ponca, NE 68770-0107
Phone (402) 755-4111
Other names
- Tom M Etter
Other providers in Ponca, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.