1093806937 NPI number — HEIMENSEN FAMILY CHIROPRACTIC CTR

Table of content: (NPI 1093806937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093806937 NPI number — HEIMENSEN FAMILY CHIROPRACTIC CTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEIMENSEN FAMILY CHIROPRACTIC CTR
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:
CHIROPRACTIC ASSOCIATES OF SIOUXLAND
Provider Other Organization Name Type Code:
4
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:
1093806937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 ARIZONA AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51041-1425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-737-3850
Provider Business Mailing Address Fax Number:
712-737-3859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 ARIZONA AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51041-1425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-737-3850
Provider Business Practice Location Address Fax Number:
712-737-3859
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEIMENSEN
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER CHIROPRACTOR
Authorized Official Telephone Number:
712-737-3850

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  A05618 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 54891 . This is a "WELLMARK BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 34805 . This is a "SIOUX VALLEY HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0143776 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4642 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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