Provider Demographics
NPI:1356651483
Name:HIEBNER CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:HIEBNER CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROYCE
Authorized Official - Middle Name:LYDELL
Authorized Official - Last Name:HIEBNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-537-3691
Mailing Address - Street 1:815 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GOTHENBURG
Mailing Address - State:NE
Mailing Address - Zip Code:69138-1943
Mailing Address - Country:US
Mailing Address - Phone:308-537-3691
Mailing Address - Fax:308-537-3691
Practice Address - Street 1:815 LAKE AVE
Practice Address - Street 2:
Practice Address - City:GOTHENBURG
Practice Address - State:NE
Practice Address - Zip Code:69138-1943
Practice Address - Country:US
Practice Address - Phone:308-537-3691
Practice Address - Fax:308-537-3691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE350053505OtherMEDICARE RAILROAD
62308OtherCIGNA HEALTHCARE
NE11576OtherMIDLANDS CHOICE
NE87042OtherUPREHS
87726OtherUNITED HEALTH CARE
NE9812OtherBCBS
NE=========00Medicaid
NEU42150Medicare UPIN
62308OtherCIGNA HEALTHCARE