Provider Demographics
NPI:1447264254
Name:RETHWISCH, JEREMIAH JON (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:JON
Last Name:RETHWISCH
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 1:18010 R PLZ
Mailing Address - Street 2:STE 104
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135
Mailing Address - Country:US
Mailing Address - Phone:402-980-6991
Mailing Address - Fax:402-408-6620
Practice Address - Street 1:18010 R PLZ
Practice Address - Street 2:STE 104
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135
Practice Address - Country:US
Practice Address - Phone:402-980-6561
Practice Address - Fax:402-408-6620
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
09583OtherBLUE CROSS BLUE SHIELD
NEP00207772OtherRAILROAD MEDICARE
NEP00207772OtherRAILROAD MEDICARE
NE278686Medicare PIN
278686Medicare ID - Type Unspecified
09583OtherBLUE CROSS BLUE SHIELD