Provider Demographics
NPI:1497758676
Name:VANHEMERT, RUSSELL R (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:R
Last Name:VANHEMERT
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-0026
Mailing Address - Country:US
Mailing Address - Phone:641-628-2099
Mailing Address - Fax:641-628-2324
Practice Address - Street 1:1310 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1512
Practice Address - Country:US
Practice Address - Phone:641-628-2099
Practice Address - Fax:641-628-2324
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-10-23
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
IA04934111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1710013719OtherNPI CORPORATION NUMBER
IA0231951Medicaid
IAI11625Medicare ID - Type UnspecifiedPERSONAL PROVIDER NUMBER
IAT01320Medicare UPIN
IA0231951Medicaid