Provider Demographics
NPI:1093806937
Name:HEIMENSEN FAMILY CHIROPRACTIC CTR
Entity Type:Organization
Organization Name:HEIMENSEN FAMILY CHIROPRACTIC CTR
Other - Org Name:CHIROPRACTIC ASSOCIATES OF SIOUXLAND
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEIMENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-737-3850
Mailing Address - Street 1:111 ARIZONA AVE NW
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1425
Mailing Address - Country:US
Mailing Address - Phone:712-737-3850
Mailing Address - Fax:712-737-3859
Practice Address - Street 1:111 ARIZONA AVE NW
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1425
Practice Address - Country:US
Practice Address - Phone:712-737-3850
Practice Address - Fax:712-737-3859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA54891OtherWELLMARK BCBS
IA34805OtherSIOUX VALLEY HEALTH
IA0143776Medicaid
IA4642OtherMIDLANDS CHOICE
IA0143776Medicaid
IA4642OtherMIDLANDS CHOICE