1356651483 NPI number — HIEBNER CHIROPRACTIC CLINIC, P.C.

Table of content: (NPI 1356651483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356651483 NPI number — HIEBNER CHIROPRACTIC CLINIC, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIEBNER CHIROPRACTIC CLINIC, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356651483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
815 LAKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOTHENBURG
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69138-1943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-537-3691
Provider Business Mailing Address Fax Number:
308-537-3691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOTHENBURG
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69138-1943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-537-3691
Provider Business Practice Location Address Fax Number:
308-537-3691
Provider Enumeration Date:
10/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HIEBNER
Authorized Official First Name:
ROYCE
Authorized Official Middle Name:
LYDELL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
308-537-3691

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1061 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 350053505 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 62308 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11576 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 87042 . This is a "UPREHS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9812 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com