Provider Demographics
NPI:1447276134
Name:CALLAHAN, JONATHAN B (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:B
Last Name:CALLAHAN
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 1:1100 N LINCOLN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-1720
Mailing Address - Country:US
Mailing Address - Phone:402-362-3251
Mailing Address - Fax:402-362-1413
Practice Address - Street 1:1100 N LINCOLN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-1720
Practice Address - Country:US
Practice Address - Phone:402-362-3251
Practice Address - Fax:402-362-1413
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47067381001Medicaid
NE09629OtherBCBS NEBRASKA
NE8926OtherMIDLANDS CHOICE
NET40202Medicare UPIN
NE47067381001Medicaid