Provider Demographics
NPI:1609227446
Name:HEINRICHS, TROY THOMAS (LAC)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:THOMAS
Last Name:HEINRICHS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19951 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROCA
Mailing Address - State:NE
Mailing Address - Zip Code:68430-9649
Mailing Address - Country:US
Mailing Address - Phone:402-318-8775
Mailing Address - Fax:
Practice Address - Street 1:5221 S 48TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-2230
Practice Address - Country:US
Practice Address - Phone:402-318-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE29171100000X
CA13585171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist