Provider Demographics
NPI:1053728451
Name:FUNCTIONAL PERFORMANCE CHIROPRACTIC & WELLNESS
Entity type:Organization
Organization Name:FUNCTIONAL PERFORMANCE CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LAUENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-999-8166
Mailing Address - Street 1:15811 W DODGE RD STE 152
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-4013
Mailing Address - Country:US
Mailing Address - Phone:402-999-8166
Mailing Address - Fax:402-934-7681
Practice Address - Street 1:15811 W DODGE RD STE 152
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-4013
Practice Address - Country:US
Practice Address - Phone:402-999-8166
Practice Address - Fax:402-934-7681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1796261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center