Provider Demographics
NPI:1063510519
Name:HELLER CHIROPRACTIC, S.C.
Entity Type:Organization
Organization Name:HELLER CHIROPRACTIC, S.C.
Other - Org Name:HELLER CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:DANA
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-846-3778
Mailing Address - Street 1:517 CALDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-1139
Mailing Address - Country:US
Mailing Address - Phone:920-846-3778
Mailing Address - Fax:920-846-3877
Practice Address - Street 1:517 CALDWELL AVE
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1139
Practice Address - Country:US
Practice Address - Phone:920-846-3778
Practice Address - Fax:920-846-3877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3043-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38904000Medicaid
WI38904000Medicaid
WIU48615Medicare UPIN