1356472286 NPI number — HEARTLAND FAMILY HEALTH & CHIROPRACTIC CLINIC, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356472286 NPI number — HEARTLAND FAMILY HEALTH & CHIROPRACTIC CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTLAND FAMILY HEALTH & CHIROPRACTIC CLINIC, INC.
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:
6
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:
1356472286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1861 E 23RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREMONT
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68025-2437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-721-1060
Provider Business Mailing Address Fax Number:
402-727-4761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1715 N BELL ST
Provider Second Line Business Practice Location Address:
OPTIONAL
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68025-3158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-721-1060
Provider Business Practice Location Address Fax Number:
402-727-4761
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAMENZIND
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-721-1060

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1023 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 1063 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 36613 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: ========= , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36612 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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