28D0455674 CLIA NUMBER - TRI-STATE PHYSICIANS & PHYSICAL THERAPY CLINIC PC

Laboratory Demographics

  • CLIA Code: 28D0455674
  • Facility Name: TRI-STATE PHYSICIANS & PHYSICAL THERAPY CLINIC PC
  • Facility Address: 3900 DAKOTA AVENUE SUITE #6
    SOUTH SIOUX CITY, NE
    ZIP 68776
  • Facility Phone: 402 494-5173
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PAT LUSE
  • NPI Number: 1114180767
  • Taxonomy: 111N00000X - Chiropractor

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CLIA Record

Field Name Field Value
CLIA Number 28D0455674
LAB Type Physician Office
Facility Name TRI-STATE PHYSICIANS & PHYSICAL THERAPY CLINIC PC
Street 3900 DAKOTA AVENUE SUITE #6
City SOUTH SIOUX CITY
State NE
ZIP 68776
Phone 402 494-5173
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director PAT LUSE

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This page was last updated on: 9/29/2025