Nicolas Jim Fanning, D.C., M.S.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1567 Issued in NE

Practice address

10 N Spruce St
Ogallala, NE 69153-2549

Phone

(402) 310-5790

NPI assigned

May 14, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Specialty

Chiropractic

Education

Logan College of Chiropractic, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vitality Chiro PC

  • Chiropractor
  • Ogallala, NE
  • NPI 1376830810
  Medicare reassignment NPD Authorized official
• Vitality Chiro PC

  • Chiropractor
  • Arthur, NE
  • NPI 1255721189
  NPD (past) Authorized official

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

{
    "created_epoch": "1242259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309824000000",
    "number": "1760616023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 96",
            "city": "OGALLALA",
            "state": "NE",
            "postal_code": "691530096",
            "telephone_number": "402-310-5790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 N SPRUCE ST",
            "city": "OGALLALA",
            "state": "NE",
            "postal_code": "691532549",
            "telephone_number": "402-310-5790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANNING",
        "first_name": "NICOLAS",
        "middle_name": "JIM",
        "name_prefix": "Dr.",
        "credential": "D.C., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-14",
        "last_updated": "2011-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NE",
            "license": "1567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025511400",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Teresa Ann Detlefsen
• Librada Diaz-Wood
• Educational Service Unit 16
• Lisa Einspahr
• Family Medical Center, P.C.
• Kendra Fink, OD
• Edward F Fogarty III, MD
• Beverly Ann Frates McMahon, MS LMHP LADC
• Jill Funk
• David H Garfield, M.D.

• All providers in Ogallala, NE
• Chiropractor in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2011; 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.