Provider Demographics
NPI:1356472286
Name:HEARTLAND FAMILY HEALTH & CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:HEARTLAND FAMILY HEALTH & CHIROPRACTIC CLINIC, INC.
Other - Org Name:HEARTLAND CHIROPRACTIC CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMENZIND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-721-1060
Mailing Address - Street 1:1861 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2437
Mailing Address - Country:US
Mailing Address - Phone:402-721-1060
Mailing Address - Fax:402-727-4761
Practice Address - Street 1:1715 N BELL ST
Practice Address - Street 2:OPTIONAL
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-3158
Practice Address - Country:US
Practice Address - Phone:402-721-1060
Practice Address - Fax:402-727-4761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1023111N00000X
NE1063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36613OtherBCBS PROVIDER NUMBER
NE=========Medicaid
NE36612OtherBCBS PROVIDER NUMBER
NEU42149Medicare UPIN
NE=========12Medicaid
NE36613OtherBCBS PROVIDER NUMBER