Provider Demographics
NPI:1144303306
Name:METCALF, KENNETH ROSS (DC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ROSS
Last Name:METCALF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:METCALF CHIROPRACTIC CENTER
Mailing Address - Street 2:3201 PIONEERS BLVD. STE #32
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-5963
Mailing Address - Country:US
Mailing Address - Phone:402-486-1212
Mailing Address - Fax:402-484-8532
Practice Address - Street 1:METCALF CHIROPRACTIC CENTER
Practice Address - Street 2:3201 PIONEERS BLVD. STE #32
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-5963
Practice Address - Country:US
Practice Address - Phone:402-486-1212
Practice Address - Fax:402-484-8532
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09671OtherBLUE CROSS-BLUE SHIELD
NE47-068526200Medicaid
NE097670Medicare ID - Type Unspecified