Provider Demographics
NPI:1003816919
Name:HINZE, RANDY RALPH (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:RALPH
Last Name:HINZE
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 1:2421 23RD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-3305
Mailing Address - Country:US
Mailing Address - Phone:402-564-9447
Mailing Address - Fax:402-564-7888
Practice Address - Street 1:2421 23RD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-3305
Practice Address - Country:US
Practice Address - Phone:402-564-9447
Practice Address - Fax:402-564-7888
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE9515OtherBLUE CROSS BLUE SHIELD
NE092170OtherPTAN
NE47063696713Medicaid
091472Medicare ID - Type UnspecifiedINDIVIDUAL
NE47063696713Medicaid