Individual
DR. DOUGLAS VANDER BROEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
6511 SHENANDOAH DR, LINCOLN, NE 68510-4195
(402) 730-4409
Mailing address
6511 SHENANDOAH DR, LINCOLN, NE 68510-4195
(402) 730-4409
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
790
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
091515
MEDICARE PTAN
NE
01
—
47-0677634
IRS/FEDERAL EMPLOYER ID N
NE
05
—
47-067763401
—
NE
Enumeration date
06/01/2005
Last updated
11/02/2015
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