Provider Demographics
NPI:1598766586
Name:HELLER, RUSSELL GENE (DC)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:GENE
Last Name:HELLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVID CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68632-1624
Mailing Address - Country:US
Mailing Address - Phone:402-367-6061
Mailing Address - Fax:402-367-4220
Practice Address - Street 1:528 N 4TH ST
Practice Address - Street 2:
Practice Address - City:DAVID CITY
Practice Address - State:NE
Practice Address - Zip Code:68632-1624
Practice Address - Country:US
Practice Address - Phone:402-367-6061
Practice Address - Fax:402-367-4220
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE974111N00000X
MO5802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025923600Medicaid
NE27355OtherBCBS
NEU10907Medicare UPIN
NENA1771Medicare PIN