Provider Demographics
NPI:1033275508
Name:HEARTLAND CHIROPRACTIC TRUST
Entity Type:Organization
Organization Name:HEARTLAND CHIROPRACTIC TRUST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DESCO
Authorized Official - Last Name:HELVESTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-773-9713
Mailing Address - Street 1:1528 ALTMAN RD
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-8606
Mailing Address - Country:US
Mailing Address - Phone:863-773-9713
Mailing Address - Fax:863-773-2489
Practice Address - Street 1:1528 ALTMAN RD
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-8606
Practice Address - Country:US
Practice Address - Phone:863-773-9713
Practice Address - Fax:863-773-2489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70647Medicare ID - Type Unspecified
FLT85474Medicare UPIN