Countryside Chiropractic, PC
Organization Active NPI Chiropractor · Crete, NE
NPI 1497949523 · NPPES record last updated Nov 26, 2012
Key facts
- NPI
- 1497949523
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 970 (NE)
- Legal business name
- COUNTRYSIDE CHIROPRACTIC, PC
- Practice address
- 1106 Main Ave
Crete, NE 68333-2258 - Phone
- (402) 826-5097
- Fax
- (402) 826-5200
- NPI assigned
- Aug 31, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Carry R Crist, D.C.
- Title
- Vice President
- Phone
- (402) 826-5097
Practitioners 2
-
Carry R Crist, D.C,
-
Julie M Crist, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051003000440 | NE | Part B Supplier - Clinic/Group Practice | 1951336536 |
Receives reassigned benefits from 2 practitioners Practice locations: Crete, NE |
National Provider Directory
Locations
1106 Main Ave
Crete, NE 68333
Phone (402) 826-5097
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 970 | NE | Yes |
Addresses
Primary practice location
1106 Main Ave
Crete, NE 68333-2258
Mailing address
1106 Main Ave
Crete, NE 68333-2258
Phone (402) 826-5097
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D09554 | Other | NE | BCBS |
Other names
- Crist Family Chiropractic
Other providers in Crete, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 26, 2012. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.