Provider Demographics
NPI:1538169412
Name:WAHL, BRUCE E (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:E
Last Name:WAHL
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 1:220 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-2237
Mailing Address - Country:US
Mailing Address - Phone:402-826-5151
Mailing Address - Fax:402-826-5152
Practice Address - Street 1:220 E 13TH ST
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-2237
Practice Address - Country:US
Practice Address - Phone:402-826-5151
Practice Address - Fax:402-826-5152
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE44-00145OtherUNITED HEALTH CARE
NE09780OtherBLUE CROSS BLUE SHIELD
NE47068002700Medicaid
NE091531WAMedicare ID - Type Unspecified
NE47068002700Medicaid