Provider Demographics
NPI:1437196722
Name:HIDEMAN CHIROPRACTIC
Entity Type:Organization
Organization Name:HIDEMAN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:HIDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-533-0770
Mailing Address - Street 1:1131 S INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6207
Mailing Address - Country:US
Mailing Address - Phone:574-533-0770
Mailing Address - Fax:574-534-0770
Practice Address - Street 1:1131 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6207
Practice Address - Country:US
Practice Address - Phone:574-533-0770
Practice Address - Fax:574-534-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000387548OtherANTHEM PIN
IN000000387548OtherANTHEM PIN