Provider Demographics
NPI:1477739795
Name:HEARTLAND CLINIC CHIROPRACTIC PC
Entity Type:Organization
Organization Name:HEARTLAND CLINIC CHIROPRACTIC PC
Other - Org Name:HEARTLAND CLINIC OF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:KIEFAT
Authorized Official - Suffix:
Authorized Official - Credentials:DC, BSC
Authorized Official - Phone:701-746-5977
Mailing Address - Street 1:2525 DEMERS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-8622
Mailing Address - Country:US
Mailing Address - Phone:701-746-5977
Mailing Address - Fax:701-746-5976
Practice Address - Street 1:2525 DEMERS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-8622
Practice Address - Country:US
Practice Address - Phone:701-746-5977
Practice Address - Fax:701-746-5976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND23135OtherBCBS OF NORTH DAKOTA
MN064K8HEOtherBCBS OF MINNESOTA
ND12742Medicaid
MN622662100Medicaid
ND23135OtherBCBS OF NORTH DAKOTA
N23135Medicare PIN