Provider Demographics
NPI:1205457942
Name:COREY DOUSHARM DC PC
Entity type:Organization
Organization Name:COREY DOUSHARM DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOUSHARM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-613-8812
Mailing Address - Street 1:4645 NORMAL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5823
Mailing Address - Country:US
Mailing Address - Phone:402-483-6633
Mailing Address - Fax:402-483-6919
Practice Address - Street 1:4645 NORMAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5823
Practice Address - Country:US
Practice Address - Phone:402-483-6633
Practice Address - Fax:402-483-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025715800Medicaid
NE27222OtherBLUE CROSS BLUE SHIELD
1578700068OtherNPI INDIVIDUAL